To compare occlusal relationship in patients undergoing neonate versus conventional lip surgery (LS) with and without infant orthopedics (IO) by assessment of dental arch relationship in individuals with complete unilateral cleft lip and palate.
Material and Methods:
Three groups treated by different protocols; Group I: neonate LS (1-15 days) + IO and palatoplasty (13-31 months); Group II: LS (3-12 months) + IO and palatoplasty (15-35 months); and Group III: LS (3-6 months) without IO and palatoplasty (12-18 months). The 112 intraoral photographs of individuals of all groups, obtained between 6 and 12 years of age, were assessed by the occlusal index for intraoral photograph rating. The groups were compared by the χ2 test. The correlation between surgical timing and the scores was tested by the Spearman test (P < .05).
Results:
Group I presented the highest percentage of score 5, group II exhibited highest percentage of score 1, and group III presented the lowest percentage of score 5 according to the χ2 test (P = .029). The Spearman correlation test revealed statistically significant difference between timing of LS and the occlusal index. The earlier the surgical timing, the higher the occlusal index (P = .019).
Conclusions:
Infant orthopedics has demonstrated the possibility of postponing primary plastic surgeries. Patients submitted to late lip and palate repair had the best prognosis, while patients undergoing lip repair from 1 to 15 days of life, even operating the palate later, had the worst prognosis. Neonate LS negatively influenced the occlusal relationships.
AkinYUlgenRGencosmanogluRDoganS. Early cheiloplasty: its effects on alveolar cleft. Eur J Plast Surg. 1991;14:164–167.
2.
AtackNEHathornIMarsMSandyJR. Study models of 5 year old children as predictors of surgical outcome in unilateral cleft lip and palate. Eur J Orthod. 1997a;19(2):165–170.
3.
BardachJBakowskaJMcDermott-MurrayJMooneyMPDusdiekerLB. Lip pressure changes following lip repair in infants with unilateral clefts of the lip and palate. Plast Reconstr Surg. 1984;74(4):476–481.
4.
BardachJMooneyMP. The relationship between lip pressure following lip repair and craniofacial growth: an experimental study in beagles. Plast Reconstr Surg. 1984;73(4):544–555.
5.
BennunRDPerandonesCSepliarskyVAChantiriSNAguirreMIDogliottiPL. Nonsurgical correction of nasal deformity in unilateral complete cleft lip: a 6-year follow-up. Plast Reconstr Surg. 1999;104(3):616–630.
6.
BokhoutBvan LoverenCHofmanFXWMBuijsJFvan LimbeekJPrahl-AndersenB. Prevalence of Streptococcus mutans and lactobacilli in 18- month-old children with cleft lip and/or palate. Cleft Palate Craniofac J. 1996b;33(5):424–428.
7.
BousRMKochenourNValiathanM. A novel method for fabricating nasoalveolar molding appliances for infants with cleft lip and palate using 3-dimensional workflow and clear aligners. Am J Orthod Dent Orthop. 2020;158(3),452–458.
8.
BurstonWR. The early orthodontic treatment of cleft palate conditions. Transactions of the BSSO. Dental Practitioner. 1958;9:41–56.
9.
Capelozza FilhoLNormandoADSilva FilhoOG. Isolated influences of lip and palate surgery on facial growth: comparison of operated and unoperated male adults with UCLP. Cleft Palate Craniofac J. 1996;33(1):51–56.
10.
DesaiS. Early cleft palate repair completed before the age of 16 weeks: observations on a personal series of 100 children. Br J Plast Surg. 1983;36(3):300–304.
11.
DiBiaseATDiBiaseDDHayNJSommerladBC. The relationship between arch dimensions and the 5-year index in the primary dentition of patients with complete UCLP. Cleft Palate Craniofac J. 2002;39(6):635–640.
12.
DoganSOlmezSSembG. Comparative assessment of dental arch relationships using Goslon Yardstick in patients with unilateral complete cleft lip and palate using dental casts, two-dimensional photos and three-dimensional images. Cleft Palate Craniofac J. 2012;49(3):347–351.
13.
ElsayedEHEltramsyAAbdelrahimB. Early cleft lip repair. AAMJ. 2012;10(1):Suppl.
14.
EzzatCFChavarriaCTeichgraeberJFChenJWStratmannRGGatenoJXiaJJ.. Presurgical nasoalveolar molding therapy for the treatment of unilateral cleft lip and palate: a preliminary study. Cleft Palate Craniofac J. 2007;44(1):8–12.
15.
FarronatoGKairyteTGianninLGalbiatiGMasperoC. How various surgical protocols of the unilateral cleft lip and palate influence the facial growth and possible orthodontic problems? Which is the best timing of lip, palate and alveolus repair? Literature review. Balt Dent Maxillofac J. 2014;16(2):53–60.
16.
FisherD. Correction of the alveolar gap and nostril deformity by presurgical passive orthodontia in the unilateral cleft lip. Ann Plast Surg. 2007;59(5):489–494.
17.
FriedeH. Growth sites and growth mechanisms at risk in cleft lip and palate. Acta Odontol Scand. 1998;56(6):346–351.
18.
GagliardiFCardosoIL. Van der Woude syndrome and implications in dental medicine. J Dent Craniofac Res. 2018;3(1):1–8.
19.
GalinierPSalazardBDeberailAVitkovitchFCaovanCChausserayGAcarPSamiKGuitardJSmailN.. Neonatal repair of cleft lip: a decision-making protocol. J Pediatr Surg. 2008;43(4):662–667.
20.
GarfinkleJKingTWGraysonBHBrechtLECuttingCB. A 12-year anthropometric evaluation of the nose in bilateral cleft lip–cleft palate patients following nasoalveolar molding and cutting bilateral cleft lip and nose reconstruction. Plast Reconstr Surg. 2011;127(4):1659–1667.
21.
GarrahyAMillettDTAyoubAF. Early assessment of dental arch development in repaired unilateral cleft lip and unilateral cleft lip and palate versus controls. Cleft Palate Craniofac J. 2005;42(4):385–391.
22.
GnoinskiWM. Early maxillary orthopaedics as a supplement to conventional primary surgery in complete cleft lip and palate cases—long-term results. J Maxillofac Surg. 1982;10(3):165–172.
23.
GongXDangRXuTYuQZhengJ. Full digital workflow of nasoalveolar molding treatment in infants with cleft lip and palate. J Craniofac Surg. 2020;31(2):367–371.
24.
GoodacreTEHentgesFMossTLShortVMurrayL. Does repairing a cleft lip neonatally have any effect on the longer-term attractiveness of the repair?Cleft Palate Craniofac J2004;41(6):603–608.
GraysonBHCuttingCB. Presurgical nasoalveolar orthopedic molding in primary correction of the nose, lip, and alveolus of infants born with unilateral and bilateral clefts. Cleft Palate Craniofac J. 2001;38(3):193–198.
27.
GraysonBHSantiagoPEBrechtLECuttingCB. Presurgical nasoalveolar molding in infants with cleft lip and palate. Cleft Palate Craniofac J. 1999;36(6):486–498.
28.
GuedesKMAGuimarãesAMDNBastosADSSalvianoKGSalesNJAlmeidaMLGurgelRQ. Stomatognathic evaluation at five years of age in children born premature and at term. BMC Pediatr. 2015;15(1):2. doi:10.1186/s12887-015-0343-6
29.
HarrisAPOliverNKSlaterPMurdochLMossALH. Safety of neonatal cleft lip repair. J Plast Surg Hand Surg. 2010;44(4-5):231–236.
30.
HassaniHChenJ-WZhangWHamraW. Comparison of microbial activity among infants with or without using presurgical nasoalveolar molding appliance. Cleft Palate Craniofac J. 2020;57(6):762–769.
31.
HathawayRDaskalogiannakisJMercadoARussellKLongREJrCohenMSembGShawW. The Americleft study: an inter-center study of treatment outcomes for patients with unilateral cleft lip and palate—part 2. Dental Arch Relationships. Cleft Palate Craniofac J. 2011;48(3):244–251.
32.
HefertO. Fundamental investigations into the problems related to cleft palate surgery. Br J Plast Surg. 1958;11:97–105.
33.
HorswellBBPospisilOA. Nasal symmetry after primary cleft lip repair: comparison between Delaire cheilorhinoplasty and modified rotation-advancement. J Oral Maxillofac Surg. 1995;53(9):1025–1030.
34.
HosseiniHRKaklamanosEGAthanasiouAE. Treatment outcomes of pre-surgical infant orthopedics in patients with non-syndromic cleft lip and/or palate: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2017;12(7):e0181768.
35.
HotzM. Pre-and early post-operative growth-guidance in cleft lip and palate cases by maxillary orthopedics. Cleft Palate J. 1969;6:361–372.
36.
HotzMGnoinskiW. Effects of early maxillary orthopaedics in coordination with delayed surgery for cleft lip and palate. J Maxillofac Surg. 1979;7(3):201–210.
37.
HotzMGnoinskiWNussbaumerHKistlerE. Early maxillary orthopedics in CLP cases: guidelines for surgery. Cleft Palate J. 1978;15(4):405–411.
38.
HuangCSWangWILiouEJChenYRChenPKNoordhoffMS. Effects of cheiloplasty on maxillary dental arch development in infants with unilateral complete cleft lip and palate. Cleft Palate Craniofac J. 2002;39(5):513–516.
39.
HuddartAG. An evaluation of presurgical treatment. Br J Orthod. 1974;1(2):21–25.
40.
JacobsonBNRosensteinSW. Early maxillary orthopedics for the newborn cleft lip and palate patient. Angle Orthod. 1984;54(3):247–263.
41.
JaegerMBraga-SilvaJGehlenDSatoYZukerRFisherD. Correction of the alveolar gap and nostril deformity by pre- surgical passive orthodontia in the unilateral cleft lip. Ann Plast Surg. 2007;59(5):489–494.
42.
JayashreeMPaulS. Naso Alveolar molding in early management of Cleft Lip and palate. J Indian Prosthodont Soc. 2013;13(3):362–365.
43.
JiriBJanaVMichalJJiriKDanaHMiroslavTMilosCZdenekKJaroslavFJanJ, et al.Successful early repair neonatal of cleft lip within first 8 days of live. Int Pediatr Otorhinolaryngol. 2012;76(11):1616–1626.
44.
KapadiaHOlsonDTseRSusarlaSM. Nasoalveolar molding for unilateral and bilateral cleft lip repair. Oral Maxillofac Surg Clin North Am. 2020;32(2):197–204.
45.
KhavaninNJennyHJodehDSScottMARottgersSASteinbergJP. Cleft and craniofacial team orthodontic care in the United States: a survey of the ACPA. Cleft Palate Craniofac J. 2019;56(7):860–866.
46.
KobergWKoblinI. Speech development and maxillary growth in relation to technique and timing of palatoplasty. J Maxillofac Surg. 1973;1(1):44–50.
47.
Kuijpers-JagtmanAMLongRE. The influence of surgery and orthopedic treatment on maxillofacial growth and maxillary arch development in patients treated for orofacial clefts. Cleft Palate Craniofac J. 2000;37(6):1–12.
48.
LapaFS. Passive Maxillary Orthopedic Device in the Treatment of Unilateral Cleft Lip and Palate [PhD thesis]. University of Sao Paulo, BR; 1970.
49.
LiWLiaoLDaiJZhongYRenLLiuY. Effective retropulsion and centralization of the severely malpositioned premaxilla in patients with bilateral cleft lip and palate: a novel modified presurgical nasoalveolar molding device with retraction screw. J Craniomaxillofac Surg. 2014;42(8):1903–1908.
50.
LiYShiBSongQGZuoHZhengQ. Effects of lip repair on maxillary growth and facial soft tissue development in patients with a complete unilateral cleft of lip, alveolus and palate. J Craniomaxillofac Surg. 2006;34(6):355–361.
51.
LiaoYFHuangCSLinIF. Intraoral photographs for rating dental arch relationships in unilateral cleft lip and palate. Cleft Palate Craniofac J. 2009;46(4):415–419.
52.
LiljaJMarsMElanderA. Analysis of dental arch relationships in Swedish unilateral cleft lip and palate subjects: 20–year longitudinal consecutive series treated with delayed hard palate closure. Cleft Palate Craniofac J. 2006;43(5):606–611.
53.
LiouEJSubramanianMChenPK, et al.The progressive changes of nasal symmetry and growth after nasoalveolar molding: a three-year follow-up study. Plast Reconstr Surg. 2004;114(4):858–864.
54.
LopesLD.Analysis of Early Orthopedics Followed by Two Surgical Cheiloplasty Techniques in Patients With Bilateral Cleft Lip and Palate [PhD thesis]. University of São Paulo, BR; 1986.
55.
MarsMPlintDAHoustonWJBBerglandOSembG. The Goslon Yardstick: a new system of assessing dental arch relationships in children with cleft lip and palate. Cleft Palate J. 1987;24(4):314–322.
MaullDJGraysonBHCuttingCBBrechtLLBooksteinFLKhorrambadiDWebbJAHurwitzDJ. Long-term effects of nasoalveolar molding on three-dimensional nasal shape in unilateral clefts. Cleft Palate Craniofac J. 1999;36(5):391–397.
58.
McauliffeNJonesAPCumberbirchVCRussellJI. The use of the 5-Years-Olds index: comparison between study models and intraoral photographs. Cleft Palate Craniofac J. 2011;48(5):526–531.
59.
McCombH. Primary correction of unilateral cleft lip nasal deformity: a 10 year review. Plast Reconstr Surg. 1985;75(6):791–799.
60.
McheikJNLevardG. Growth in infants in the first two years of life after neonatal repair for unilateral cleft lip and palate. Int J Pediatr Otorhinolaryngol. 2010;74(5):465–468.
61.
McheikJNLevardGVergnesPBondonnyJM. Early repair for infants with cleft lip. retrospective study of 263 cleft lip repairs. Ann Chir Plast Esthet. 2002;47(3):204–209.
62.
McheikJNSfalliPBondonnyJMLevardG. Early repair for infants with cleft lip and nose. Int J Pediatr Otorhinolaryngol. 2006;70(10):1785–1790.
63.
McNeilCK. Orthodontic procedures in the treatment of congenital cleft palate. Dent Record. 1950;70(5):126–132.
64.
MengTShiBWangQZhengQWuMHuangLLongJLiSWangYLiB. A comparative study of maxillary growth following rotation-advancement and triangular flap unilateral cleft lip repairs: an experimental study in rabbits. Ann Plast Surg. 2007;58(4):434–440.
65.
MiloroMGhaliGELarsenPWaiteP. Peterson’s Principles of Oral and Maxillofacial Surgery. 2nd ed, BC Decker Inc.; London (1): 583; 2004.
66.
MullikenJB. Bilateral complete cleft lip and nasal deformity: an anthropometric analysis of staged to synchronous repair. Plast Reconstr Surg. 1995;96(1):9–23.
67.
MurthyPSDeshmukhSBhagyalakshmiASrilathaKT. Pre surgical nasoalveolar molding: changing paradigms in early cleft lip and palate rehabilitation. J Int Oral Health. 2013;5(2):70–80.
68.
Ortiz-MonasterioFSerranoABarreraG. A study of untreated adult cleft palate patients. Plast Reconstr Surg. 1966;38(1):36–41.
69.
OzawaTODutkaJCRGaribDLaurisRCMCAlmeidaAMde Sousa BroscoTVLaurisJRPDolceCPegoraro-KrookMI. Influence of surgical technique and timing of primary repair on interarch relationship in UCLP: A randomized clinical trial. Orthod Craniofac Res. 2020; 00: 1–8.
70.
PaiBCKoEWHuangCSLiouEJ. Symmetry of the nose after presurgical nasoalveolar molding in infants with unilateral cleft lip and palate: a preliminary study. Cleft Palate Craniofac J. 2005;42(6):658–663.
71.
PapadopoulosMAKoumpridouENVakalisMLPapageorgiouSN. Effectiveness of pre-surgical infant orthopedic treatment for cleft lip and palate patients: a systematic review and meta-analysis. Orthod Craniofac Res. 2012;15(4):207–236.
72.
PereiraRMRMeloEMCCoutinhoSBValeDMSiqueiraNAlonsoN. Evaluation of craniofacial growth in patients with cleft lip and palate undergoing one-stage palate repair. Rev Bras Cir Plást. 2011;26(4):624–630.
73.
PrahlCKuijpers-JagtmanAMVan’t HofMAPrahl-AndersenB. A randomised prospective clinical trial into the effect of infant orthopedics on maxillary arch dimensions in unilateral cleft lip and palate (Dutchcleft). Eur J Oral Sci. 2001;109(5):297–305.
74.
RauARitschlLMMückeTWolffK-DLoeffelbeinDJ. Nasoalveolar molding in cleft care—experience in 40 patients from a single centre in Germany. PLoS One. 2015;10(3):e0118103.
75.
RosensteinSW. A new concept in the early orthopedic treatment of cleft lip and palate. Int J Orthod Dent Child. 1969;55(6):765–775.
76.
RossRB. Treatment variables affecting facial growth in unilateral cleft lip and palate: part 5. Timing of palate repair. Cleft Palate J. 1987;24(1):54–63.
77.
Rossell-PerryPOlivencia-FloresCDelgado-JimenezMPOrmeño-AquinoR. Surgical nasoalveolar molding: A rational treatment for bilateral cleft lip nose and systematic review. Plast Reconstr Surg Glob Open. 2020;8(9):e3082.
78.
SandbergDJMageeWPDenkM. Neonatal cleft lip and cleft palate repair. AORN J. 2002;75(3):488–499.
79.
SatoshiTAyumuTYoshihisaKSachioTHiroyukiO. Presurgical naso-alveolar molding paired with cheiloplasty to treat median cleft lip deformity in holoprosencephaly. Plast Surg Hand Surg. 2020;7(1):1,50–53.
80.
SchweckendiekWDozP. Primary veloplasty: long-term results without maxillary deformity: a twenty-five year report. Cleft Palate J. 1978;15(3):268–274.
81.
SembBBrattströmVMølstedKPrahl-AndersenBZuurbierPRumseyNShawWC. The Eurocleft study: intercenter study of treatment outcome in patients with complete cleft lip and palate. Part 4: relationship among treatment outcome, patient/parent satisfaction, and the burden of care. Cleft Palate Craniofac J. 2005b;42(1):83–92.
82.
ShawWCSembG. Current approaches to the orthodontic management of cleft lip and palate. J R Soc Med. 1992;83(1):30–33.
83.
ShiBLoseeJE. Maxillofacial growth of cleft patients. Int J Oral Sci. 2015;7(1):14–17.
84.
SischoLChanJWSteinMSmithCVan AalstJBroderHL. Nasoalveolar molding: prevalence of cleft centers offering NAM and who seeks It. Cleft Palate Craniof J. 2012;49(3):270–275.
85.
SitzmanTJMaraCALongREDaskalogiannakisJRussellKAMercadoAMHathawayRRCarleACSembGShawWC. The Americleft project: burden of care from secondary surgery. Plast Reconstr Surg. 2015:3(7):E442.
86.
SteinSDunscheAGellrichNCHärleFJonasI. One- or two-stage palate closure in patients with unilateral cleft lip and palate: comparing cephalometric and occlusal outcomes. Cleft Palate Craniofac J. 2007;44(1):13–22.
87.
TakatoTYoneharaYSusamiT.Early correction of the nose in unilateral cleft lip patients using an open method: a 10-year review. J Oral Maxillofac Surg. 1995;53(1):28–33.
88.
UzelAAlparslanZN. Long-term effects of presurgical infant orthopedics in patients with cleft lip and palate: a systematic review. Cleft Palate Craniofac J2011;48(5):587–595.
89.
Van der HeijdenPDijkstraPUStellingsmaCvan der LaanBFKorsten-MeijerAGWGoorhuis-BrouwerSM. Limited evidence for the effect of presurgical nasoalveolar molding in unilateral cleft on nasal symmetry. Plast Reconstr Surg. 2013;131(1):62e–71e.
90.
Van LoverenCBujisJFBokhoutBPrahl-AndersenBTen CateJM. Incidence of mutans streptococci and lactobacilli in oral cleft children wearing acrylic plates from shortly after birth. Oral Microbiol Immunol. 1998;13(5):286–291.
91.
YangCHuangNShiB. Clinical research of presurgical orthodontic treatment of complete cleft lip and palate infant. Hua Xi Kou Qiang Yi Xue Za Zhi. 2011;29(4):396–399.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
