Specification of the multidisciplinary treatment process of cleft lip and palate during pregnancy, prenatal and postnatal stages / 中华口腔医学杂志

The prevention, prenatal diagnosis and postnatal treatment of cleft lip and palate form a comprehensive treatment process requiring multidisciplinary participation. Prevention and treatment of cleft lip and palate involve multiple disciplines. The timing of professional intervention often cross and overlap, intervention and the sequence of treatment had a great influence on the outcome of the treatment. In the meantime, under the premise of the change of national fertility policy, the reproductive needs of families with cleft lip and palate, such as fertility intervention and diagnosis etc., should be paid attention to through the whole chain of pre-pregnant, prenatal and post-natal interventions. Therefore, this paper proposes a multidisciplinary treatment process for the comprehensive diagnosis and treatment of cleft lip and palate. It primarily combs and standardizes the discipline composition, data preparation, consultation contents, personnel, time and technical points of the consultation records of the multidisciplinary treatment in antenatal, postnatal, infant, adolescent, adult and reproductive stages of cleft lip and palate.

Fissura labiopalatina: avaliação do impacto psicológico utilizando a Escala de Autoestima de Rosenberg / Cleft lip and palate: evaluation of the psychological impact using the Rosenberg self-esteem scale

Introdução: A fissura labiopalatina é a malformação mais frequente da região da cabeça e afeta mais de 10 milhões de pessoas no mundo. O objetivo do estudo foi avaliar a autoestima em pacientes portadores de fissura labiopalatina em acompanhamento no Serviço de Cirurgia Plástica Craniomaxilofacial do Hospital de Clínicas de Porto Alegre, comparando-os com indivíduos não fissurados. Métodos: Estudo transversal contemporâneo, com 160 participantes, sendo 80 pacientes com fissura labiopalatina já submetidos a procedimentos cirúrgicos relacionados à afecção e, como grupo controle, 80 alunos e funcionários da rede pública de ensino. Um questionário para caracterizar o grupo e a escala de autoestima de Rosenberg foram utilizados para a coleta de dados. Resultados: Houve diferença significativa entre os grupos quanto ao estado civil, escolaridade e repetência escolar. Os pacientes com fissura labiopalatina apresentam níveis de autoestima menores em relação a indivíduos não afetados. Dentre eles, os subgrupos dos indivíduos com fissura bilateral, fissura completa, do gênero feminino, classe econômica D/E, baixa escolaridade, situação familiar reconstituída na infância e com resultados não satisfatórios em relação à comunicação, dentição e cicatriz de lábio também mostraram níveis de autoestima menores. Conclusão: Houve relação significativa entre fissura labiopalatina e baixa autoestima.

Introduction: Cleft lip and palate is the most frequent malformation of the head region and affects more than 10 million people worldwide. This study aims at evaluating the selfesteem in patients with cleft lip and palate and comparing that with the self-esteem of non-affected individuals during followup at the Department of Craniomaxillofacial Plastic Surgery of the Hospital de Clínicas of Porto Alegre. Methods: This is a cross-sectional, contemporary study with 160 participants, comprising 80 patients with cleft lip and palate who have already undergone surgical procedures for correcting the condition and 80 non-affected students and employees of the publicschool system as a control group. We used a questionnaire to characterize the group and the Rosenberg self-esteem scale for data collection. Results: There was a significant difference between groups in terms of marital status, schooling, and school retention. Patients with a cleft lip and palate had lower levels of self-esteem than non-affected individuals. Among them, the individuals with bilateral clefts or complete clefts; female gender; economic strata of D/E; low level of schooling; families reconstituted during childhood; and with unsatisfactory results concerning communication, dentition, and lip scar also showed lower levels of self-esteem. Conclusion: There was a significant relationship between cleft lip and palate and low self-esteem.

Comparing osteogenic effects between concentrated growth factors and the acellular dermal matrix

Abstract Concentrated growth factor (CGF) is an autogenuous product that contains highly concentrated number of platelets and can be derived from venous blood by selective centrifugation. It has been speculated that local growth factors in human platelets (insulinlike growth factor, IGF; transforming growth factor, TGF-b; platelet derived growth factor, PDGF) would enhance healing of grafts and also counteract resorption. The osteogensis effect of CGF and acellular dermal matrix (ADM) for alveolar cleft defects was evaluated in this study. Twenty alveolar cleft patients were divided randomly into two groups. One group underwent guided bone regeneration (GBR) using acellular dermal matrix film combined with alveolar bone grafting using iliac crest bone grafts (GBR group), while the other group underwent alveolar bone grafting combined with CGF (CGF group). Cone beam computed tomography (CBCT) images were obtained at 1 week and 6 months following the procedure. Using Mimics 17.0 software, the bone resorption rate and bone density improvement rate were calculated and compared between the two groups. Although not significant between ADM and CGF in bone resorption rate, the bone density improvement in cases with CGF(61.62 ± 4.728%) was much better than in cases with ADM (27.05 ± 5.607%) (p = 0.0002). Thus, CGF could be recommended to patients with alveolar cleft as a better choice.

Perfil epidemiológico da criança e do adolescente com fissura oral atendidos em um centro de referência em Curitiba, PR, Brasil / Epidemiological profile of children and adolescents with oral cleft treated at a referral center in Curitiba, PR, Brazil

INTRODUÇÃO: A fissura oral é a segunda maior causa de anomalias congênitas e representa a principal alteração craniofacial em nascidos vivos. O objetivo do presente estudo foi determinar os dados epidemiológicos do Centro de Atenção Integral ao Fissurado Labiopalatal, no período entre janeiro de 2011 e dezembro de 2014. MÉTODOS: Estudo retrospectivo utilizando prontuários clínicos. Foram avaliados 1262 prontuários de pacientes portadores de fissura oral. Após aplicação dos critérios de inclusão e exclusão, 52,7% prontuários foram incluídos no estudo. RESULTADOS: Entre os 666 prontuários, 57,4% foram do gênero masculino e 42,6% do feminino. Verificou-se que 34,8% dos pacientes apresentaram fissuras transforame, 27,2% fissuras pré-forame, 25,8% fissuras pós-forame e 12,2% outros tipos de fissuras. Pacientes oriundos de Curitiba e Região Metropolitana correspondem a 36,6%, aqueles do Interior do Paraná abrangem 61% dos atendimentos no Centro de Atenção. As medianas de idade na primeira consulta, entre os pacientes de Curitiba e Região Metropolitana e do Interior do Paraná, são de 1 mês e 2 meses, respectivamente. E a primeira cirurgia, realizada no Centro de Atenção, foi em torno de 6 meses, nos pacientes de Curitiba e Região Metropolitana, e de 7 meses naqueles oriundos do Interior do Paraná. CONCLUSÃO: Verificou-se predomínio de fissuras em meninos e maior frequência da fissura pós-forame incompleta. Observou-se que, apesar da distância, as crianças oriundas do Interior do Paraná realizaram a cirurgia de correção e chegaram ao centro de referência com apenas um mês de diferença em relação aquelas da cidade sede do Centro de Atenção Integral ao Fissurado Labiopalatal.

INTRODUCTION: Oral cleft is the second major cause of congenital anomalies and represents a major craniofacial alteration in live births. The objective of this study was to analyze the epidemiological data collected from the Center for Comprehensive Care to Individuals with Cleft Lip and Palate in the period from January 2011 to December 2014. METHODS: This retrospective study evaluated 1,262 medical records of patients with an oral cleft. After applying the inclusion and exclusion criteria, 52.7% of the medical records were included in the study. RESULTS: Among the 666 medical records, 57.4% were of male patients and 42.6% were of female patients. Of these, 34.8% of the patients had a trans-foramen cleft, 27.2% had a pre-foramen cleft, 25.8% had a post-foramen cleft, and 12.2% had another type of cleft. Patients from Curitiba and the metropolitan region constituted 36.6% of the cases, and patients from rural areas of Paraná represented 61% of the visits to the care center. The median age at the first visit of the patients from Curitiba/metropolitan region and rural areas of Paraná was 1 and 2 months, respectively. The first surgery was performed at the care center at the age of 6 months in patients from Curitiba and metropolitan region and 7 months in patients from rural areas of Paraná. CONCLUSION: There was a predominance of boys and a higher prevalence of incomplete post-foramen clefts in the total population. Despite the long distance to the care center, children from rural areas of Paraná underwent the correction surgery and were treated at the referral center with an age difference of only 1 month compared with patients who lived in Curitiba, where the care center is located.

Premaxilla: an independent bone that can base therapeutics for middle third growth!

ABSTRACT Premaxilla, in its early descriptions, had the participation of Goethe. In our face, in a certain period of growth and development processes, premaxilla is an independent and, then, a semi-independent bone to finally be totally integrated to the maxilla. Formation of the premaxilla acts as a stabilization element inside the facial skeleton comparable to the cornerstone of a Roman arch and is closely related to the development of human face and its abnormal growth with characteristic malformations. Until when the premaxillary-maxillary suture remains open and offers opportunities to orthopedically influence facial growth to exert influence over facial esthetics and function? Contact with preliminary results in 1183 skulls from anatomic museums at USP, Unicamp and Unifesp led us to question therapeutic perspectives and its clinical applicability.

RESUMO A descrição inicial da pré-maxila teve a participação de Goethe. Na face, em determinado período do crescimento e desenvolvimento, têm-se a pré-maxila como um osso independente e, depois, semi-independente para, finalmente, se integrar totalmente à maxila. A formação da pré-maxila atua como um elemento estabilizador dentro do esqueleto facial, comparável com a pedra angular de um arco romano, e está intimamente relacionada com o desenvolvimento da face humana e seu crescimento anormal, com malformações características. Até quando a sutura pré-maxilar-maxilar continua aberta e oferece oportunidades para se influenciar ortopedicamente o crescimento facial e modificar a estética e função da face? O contato com estudos preliminares em 1.183 crânios de museus anatômicos da USP, Unicamp e Unifesp nos induziu a questionar sobre as perspectivas terapêuticas e aplicabilidades clínicas.

Individual deprivation, regional deprivation, and risk for oral clefts in Argentina / Privación económica individual y regional, y riesgo de hendiduras orofaciales en Argentina / Carência individual, carência regional e risco de fissuras orais na Argentina

ABSTRACT Objective The aim of this study was to analyze the effects of individual low socioeconomic status (SES) and deprived geographical area (GA) on the occurrence of isolated cleft lip with or without cleft palate (CL±P) in Argentina. Methods This case-control study included 577 newborns with isolated CL±P and 13 344 healthy controls, born between 1992 and 2001, from a total population of 546 129 births in 39 hospitals in Argentina. Census data on unsatisfied basic needs were used to establish the degree of geographical area deprivation. An SES index for each individual was established, using maternal age, gravidity, low paternal and maternal education, and low-level paternal occupation. Logistic regression was used to assess the effects of low SES and of deprived GA on CL±P. Results A slightly increased risk of CL±P was observed in mothers with a low SES, while a deprived GA showed no effect. Native ancestry, acute maternal illnesses, and poor prenatal care were significant risk factors for CL±P for the mothers with low SES, after using propensity scores to adjust for the demographic characteristics in cases and controls. Conclusions Low individual SES slightly increased the risk for CL±P, but a deprived GA did not have that effect. There was no interaction between individual SES and deprived GA. Factors related to low individual SES—including poor prenatal care, low parental education, lack of information, and lifestyle factors—should be primarily targeted as risk factors for CL±P rather than factors related to a deprived place of residence.

RESUMEN Objetivo Analizar los efectos de un bajo nivel socioeconómico individual y una zona geográfica desfavorable en la aparición del labio leporino aislado con o sin paladar hendido (LL ± P) en Argentina. Métodos En este estudio de casos y controles se incluyeron 577 recién nacidos con LL ± P aislado y 13 344 controles sanos nacidos entre 1992 y 2001, de un total de 546 129 nacimientos ocurridos en 39 hospitales de Argentina. Para identificar las zonas geográficas desfavorables se utilizaron datos del Índice de Necesidades Básicas Insatisfechas. Se calculó un índice de nivel socioeconómico para cada participante usando la edad materna, el número de embarazos, el nivel de instrucción bajo del padre y la madre, y el nivel de ocupación bajo del padre. Se usó regresión logística para evaluar los efectos de un bajo nivel socioeconómico y una zona geográfica desfavorable en la ocurrencia de LL ± P. Resultados Se observó un riesgo levemente mayor de LL ± P en madres con bajo nivel socioeconómico, mientras que una zona geográfica desfavorable no mostró ningún efecto. La ascendencia indígena, las enfermedades agudas maternas y una atención prenatal deficiente fueron factores de riesgo significativos para LL ± P en madres con bajo nivel socioeconómico, después de ajustar las características demográficas de casos y controles mediante análisis de propensión. Conclusiones Un bajo nivel socioeconómico aumentó levemente el riesgo de LL ± P, pero una zona geográfica desfavorable no mostró ese efecto. No hubo interacción entre un bajo nivel socioeconómico individual y una zona geográfica desfavorable. Los factores relacionados con un bajo nivel socioeconómico individual —inclusive una atención prenatal deficiente, la baja educación de los padres, la falta de información y el estilo de vida— deben abordarse principalmente como factores de riesgo de LL ± P más que los factores relacionados con una zona de residencia desfavorable.

RESUMO Objetivo Examinar os efeitos do baixo nível socioeconômico individual e área geográfica em situação de carência na ocorrência de fissura labial isolada com ou sem fissura palatina (FL ± P) na Argentina. Métodos Estudo de caso-controle que compreendeu 577 recém-nascidos com FL isolada ± P e 13 344 controles saudáveis, nascidos entre 1992 e 2001, de uma população total de 546 129 nascimentos em 39 hospitais na Argentina. Foram usados dados censitários sobre necessidades básicas existentes para estabelecer o grau de carência das áreas geográficas. Foi determinado um índice de nível socioeconômico para cada indivíduo baseado na idade materna, número de gestações, baixa escolaridade materna e paterna e ocupação paterna de baixo nível. Foi realizada uma regressão logística para avaliar os efeitos do baixo nível socioeconômico e área geográfica em situação de carência na ocorrência de FL ± P. Resultados Observou-se um risco discretamente aumentado de FL ± P em mães com baixo nível socioeconômico, mas nenhum efeito foi verificado quanto à área geográfica em situação de carência. Descendência indígena, doença materna aguda e assistência pré-natal precária foram fatores de risco importantes para FL ± P nas mães com baixo nível socioeconômico, após o uso de escores de propensão para ajustar as características demográficas em casos e controles. Conclusões O baixo nível socioeconômico individual foi associado a um discreto aumento do risco de FL ± P, mas este efeito não foi observado para área geográfica em situação de carência. Não houve interação entre nível socioeconômico individual e área geográfica em situação de carência. Fatores relacionados ao baixo nível socioeconômico individual, como assistência pré-natal precária, baixa escolaridade dos pais, falta de informação e fatores relacionados aos hábitos de vida, devem ser o foco principal porque eles são os fatores de risco para FL ± P, não fatores relacionados ao domicílio em área carente.

Demographic and clinical profile of craniofacial clefts at comprehensive rehabilitation service in Uganda

Background: The true incidence of Craniofacial cleft (CFC) is unknown because of their scarcity and because of the difficulty in recognizing sometimes subtle physical findings in mild malformations. Craniofacial anomalies in the African population are reported infrequently. Aim: To contribute to the general literature on rare CFC in Uganda and Africa. Methods: we conducted a retrospective search of patient data over the period 2005 to May 2017 in the unit of plastic surgery of CoRSU (Comprehensive Rehabilitation Service in Uganda) hospital, a tertiary hospital in Uganda. Patient with a diagnosis of CFC were picked out. Sixty-six patient's files with clinical diagnosis of CFC including their clinical photographs were found. Frequency data was generated and a frequency distribution table with the observed data was constructed. Results: Sex distribution showed no significant difference between male and female (1:1,2);the age on admission ranged from 1 day to 83 years; according to the laterality of the cleft, unilateral CFC (left or right side) are more common than midline clefts (Tessier 0; 14; 0,14;30); however, according to the clinical type, Tessier cleft (TC) 0 is the most common TC in our series and is associated with holoprosencephaly. Fifty percent of CFC in our series are syndromic. TC 7 are common in male and have a bilateral predilection. Conclusion: CFC are a rare set of malformations for which there is a paucity of literature. There is a need to conduct a study with a larger series including CT-Scan in order to analyze more accurate clinical diagnosis

Effect of presurgical orthopedics on oral-health related quality of life in chilean children with cleft lip and palate. a pilot study / Efecto de la ortopedia prequirúrgica sobre la calidad de vida relacionada con salud oral en niños chilenos con fisura labio palatina. estudio piloto

Abstract: the aim of this pilot study was to evaluate the effect of Presurgical Orthopedics (PSO) on the oral health-related quality of life (OHRQoL) in Children with Cleft Lip and Palate (CLP) treated in two hospitals in Chile using the Spanish version of the Child Oral Health Impact Profile (COHIP-Sp). Method: Cross-sectional study, involving 42 children with CLP (mean age 12 +/- 2.1 years; 28 men) who attended their annual checkup at the main Hospital of Valdivia and at the Hospital Fundacion Gantz in Santiago, Chile, between March and April 2016. Those who met the selection criteria were applied the COHIP-Sp scale. Based on their medical records, patients who used PSO as treatment protocol were classified as "PSO". Those who did not receive treatment with the appliance were classified as "Non- PSO". The score of the COHIP-Sp scale and its domains between the two groups was compared (t-test, p<0.05). Results: Twenty-five patients (59.5 percent) used PSO. COHIP-Sp score was 91.7 +/- 26.2 points in the PSO group, and 81.2 +/- 30.9 points in the Non-PSO group. There was no statistically significant difference (p=0.24). Conclusion: OHRQoL of patients with CLP treated with PSO was similar to that of patients not treated with PSO.

Resumen: el objetivo de este estudio piloto fue evaluar el efecto de la Ortopedia Pré-Quirúrgica Infantil (OPQI) sobre la calidad de vida relacionada con salud oral (CVRSO) en niños con Fisura Labio Palatina (FLP) tratados en dos hospitales de Chile usando la versión española del Child Oral Health Impact Profile (COHIP-Sp). Método: Estudio de corte transversal. Participaron 42 niños y niñas con FLP (edad promedio 12 +/- 2.1 años; 28 hombres) que asistieron a su control anual del Hospital Base de Valdivia y la Fundación Gantz en Santiago entre marzo y abril del año 2016. A quienes cumplieron los criterios de selección, se les aplicó la escala COHIP-Sp. Basándose en las fichas clínicas, se clasificó como "OPQI" aquellos pacientes que usaron OPQI como protocolo de tratamiento; y como grupo "No-OPQI" aquellos que no recibieron el tratamiento con la placa. Se comparó el puntaje de la escala COHIP-Sp y sus dominios entre ambos grupos (t-test, p<0.05). Resultados: Veinticinco pacientes (59.5 por ciento) usaron OPQI. La puntuación COHIP-Sp fue 91.7 +/- 26.2 puntos en el grupo OPQI y 81.2 +/- 30.9 puntos en grupo No-OPQI, diferencia estadísticamente no significativa (p=0.24). Conclusión: La CVRSO de pacientes con FLP tratados con OPQI fue similar a pacientes no tratados con OPQI.

Pacientes con fisura labio-alveolo-palatina: estudio descriptivo de pacientes atendidos en el Hospital Público Materno Infantil, Pcia. de Salta, entre los años 2010 y 2014 / A descriptive study of patients with FLAP at the Public Maternity Child Hospital in the province of Salta, between 2010 and 2014

La fisura labio-palatina (FLP) es una de las malformaciones congénitas más frecuentes. Si bien la fisura de labio y la fisura de paladar son distintas y pueden presentarse de manera individual o ambas en el mismo individuo, es útil estudiarlas en conjunto. La prevalencia en Argentina es menor que la media informada a nivel mundial. Esta patología requiere un tratamiento continuo y mutidisciplinario, con el fin de disminuir sus secuelas. El Hospital Público Materno Infantil (HPMI) de la provincia de Salta, es el principal centro de referencia que trabaja con niños fisurados de toda la provincia. Dada la diversidad de etnias y regiones geográficas de procedencia de los pacientes, se considera conveniente sistematizar la información. Para ello, se realizó un estudio descriptivo sobre 308 pacientes con FLAP: el sexo más afectado fue el masculino y la mayoría proviene de los Departamentos de Molinos y Los Andes. La fisura más frecuente es la unilateral izquierda completa. El 92,5 por ciento de los pacientes FLAP no presentaron asociación con síndromes y el 28,6 por ciento abandonó el tratamiento ortodóncico-ortopédico, la mayoría antes del primer año de vida. Si bien los datos aportados fueron similares a los de otros autores, ésta es la primera base de datos para la provincia de Salta. La misma permitirá realizar nuevas investigaciones y propone consignar una historia clínica estandarizada para la institución...

Necesidad de guías clínicas para el manejo integral de pacientes con labio paladar hendido / The need for clinical guidelines for the comprehensive management of patients with cleft lip and palate

Objetivo Identificar las guías clínicas para el tratamiento del labio fisurado y/o paladar hendido en menores de un año, publicadas en el país o el exterior. Método se realizó una búsqueda en tres bases de datos: Pubmed, Lilacs y Scielo con los términos "guideline cleft lip and palate", "protocols cleft lip and palate", "guía clínica labio paladar fisurado", "guía de manejo labio paladar fisurado" y "guía labio paladar hendido". Adicional a esto se consultaron las páginas web de todos los hospitales pediátricos de Colombia. Resultados Se encontraron 190 documentos de los cuales 96 no estaban relacionados con la población o enfocados en el tratamiento, 84 eran disciplinares, 8 interdisciplinarios y sólo dos guías clínicas. Conclusiones Son escasas las guías clínicas publicadas y es evidente la falta de unificación de criterios, lo que da lugar a numerosas formas de intervención y conformación de equipos interdisciplinarios. Por lo tanto, es necesario que se lleguen a consensos sobre el abordaje terapéutico para la creación de protocolos de atención con estándares de calidad y basados en la evidencia.(AU)

Objective To identify clinical guidelines for the treatment of cleft lip and / or palate in children under one year of age, published in Colombia and internationally. Method A search was conducted in three databases: PubMed, Lilacs and Scielo with the terms "guideline cleft lip and palate", "protocols cleft lip and palate", "guía clínica labio paladar fisurado", "guía de manejo labio paladar fisurado" and "guía labio paladar hendido". In addition to this, we consulted the websites of all pediatric hospitals in Colombia. Results 190 papers were found, of which 96 were not related to the population or focused on treatment, 84 were disciplinary, 8 interdisciplinary and only two were clinical guidelines. Conclusions There are few published guidelines and there is a lack of unified criteria. This gives rise to numerous forms of intervention and the creation of interdisciplinary teams. Therefore, there is a need to reach a consensus regarding the therapeutic approach in order to create treatment protocols based on evidence with quality standards.(AU)

Three-dimensional assessment of maxillary protraction with miniplates in patients with cleft lip and palate / Avaliação tridimensional da protração ortopédica da maxila com miniplacas em pacientes com fissura labiopalatina

The aim of this study was to assess maxillary, mandibular and glenoid fossa changes after bone anchored maxillary protraction (BAMP) therapy in patients with unilateral complete cleft lip and palate (UCLP). Methods: The experimental group comprised 24 patients with UCLP and maxillary sagittal deficiency with a mean initial age of 11.8 years. Cone-beam computed tomography (CBCT) exams of 24 patients with UCLP taken before (T1) and 18 months (T1) after beginning BAMP therapy were selected from the files of the Hospital of Rehabilitation of Craniofacial Anomalies. CBCTs were superimposed at the cranial base. Three-dimensional displacements of landmarks placed in surface models were quantified and visualized in color-coded maps and semi-transparency superimpositions. Kolmogorov-smirnov test was used to calculate distribution of normality. Paired t test was used to compare cleft and non-cleft sides (p<0.05). Results: A point and non-cleft central incisor displaced toward anterior (1.66mm), inferior (1.21mm) and to the cleft side. Orbitale, Infraorbitale foramen and maxillary first permanent molar displaced similarly toward anterior, inferior and medial direction. The zygoma displaced similarly toward anterior and inferior, however the cleft side showed a significantly greater lateral displacement compared to the non-cleft side. The superior concavity of the glenoid fossa showed symmetrical displacement toward anterior, lateral and superior, while the anterior and posterior eminences showed symmetrical displacements toward anterior, lateral and inferior. The mandible showed an overall symmetrical inferior and posterior displacement except for the medial pole of the condyle, which showed a significantly greater lateral displacement on the cleft side. Conclusions: Maxilla showed an anterior and inferior displacement. The glenoid fossa and the overall mandible symmetrically displaced downward and backward. The zygoma of the cleft side was the only maxillary landmark to show significantly greater lateral displacement than the non-cleft side, as well as the medial pole of the condyle on the cleft side.(AU)

O objetivo deste trabalho foi avaliar as alterações da maxila, mandíbula e fossa glenóide após o tratamento com protração maxilar ancorada em osso (BAMP) em pacientes com fissura unilateral completa de lábio e palato (UCLP). Métodos: o grupo experimental foi composto por 24 pacientes com UCLP e deficiência sagital de maxila com idade inicial de 11,8 anos. Foram selecionados exames de tomografia computadorizada de feixe cônico (CBCT) de 24 pacientes com fissura UCLP realizadas antes e após 18 meses de terapia com BAMP pertencentes ao Hospital de Reabilitação de Anomalias Craniofaciais. Os exames de CBCT foram sobrepostos pela base do crânio. Deslocamentos tridimensionais foram mensurados por meio de pontos colocados em modelos de superfície, bem como foram visualizados em mapas coloridos e sobreposições de semi-transparência. A distribuição de normalidade foi calculada por meio do teste de Kolmogorov-Smirnov. A comparação entre os lados com e sem fissura foi realizada por meio do teste t pareado (p<0.05). Resultados: O ponto A e o incisivo central superior do lado sem fissura deslocaram para anterior (1.66mm), inferior (1.21mm) e para o lado da fissura. Os pontos Orbitário, Forame Infra-orbitário e os primeiros molares permanentes superiores se deslocaram simetricamente para anterior, inferior e medial. O ponto Zigomático deslocou simetricamente para anterior e inferior, porém o lado da fissura apresentou um deslocamento significantemente maior para lateral comparado ao lado sem fissura. A concavidade superior da fossa glenóide apresentou um deslocamento simétrico para anterior, lateral e superior. As eminências anterior e posterior da fossa glenóide apresentaram um deslocamento simétrico para anterior, lateral e inferior. No geral, não houve diferença estatisticamente significante entre os lados com e sem fissura para o deslocamente inferior e posterior da mandíbula. O polo medial do côndilo foi o único ponto em que o lado da fissura apresentou um deslocamento significantemente maior para lateral quando comparado ao lado sem fissura. Conclusões: A maxila mostrou um deslocamento simétrico para anterior e inferior. A fossa glenóide e a mandíbula mostraram um deslocamento simétrico para inferior e para trás. Entretanto, os pontos zigomático e polo medial apresentaram um deslocamento lateral significantemente maior no lado da fissura.(AU)

Correção cirúrgica da macrostomia congênita unilateral e bilateral: relato de casos e revisão da literatura / Surgical correction of unilateral and bilateral congenital macrostomia: a case report and literature review

INTRODUÇÃO: A incidência da microssomia craniofacial é de 1 em 5600 nascidos vivos. É a segunda anomalia craniofacial mais comum após as fissuras labiais e palatinas. A fissura número 7 está associada entre 17 a 62% dos casos de microssomia hemifacial e começa na comissura labial, podendo prolongar-se até a linha capilar pré-auricular. As deformidades da orelha externa vão desde excesso de pele pré-auricular até ausência completa da orelha. A comissuroplastia está indicada em pacientes com macrostomia ou fissura facial lateral verdadeira. O objetivo é demonstrar dois casos de macrostomia e fazer uma revisão da literatura sobre o tema. MÉTODOS: Em nosso estudo descrevemos dois casos de macrostomia tratados com retalhos de mucosa e plástica em Z. RESULTADOS: Obtivemos um ótimo reposicionamento das comissuras nos dois pacientes, com excelente resultado estético. CONCLUSÃO: A técnica utilizada é de fácil reprodutibilidade e corrige a macrostomia estética e funcionalmente.

INTRODUCTION: The incidence of craniofacial microsomia is 1 in 5600 live births. This is the second most common craniofacial anomaly after cleft lip and palate. Tessier cleft 7 is associated with 17% to 62% of cases of hemifacial microsomia. It begins on the labial commissure and may extend to the pre-auricular capillary line. Deformities of the external ear range from excessive pre-auricular skin to complete absence of the ear. Commissuroplasty is indicated in patients with macrostomia or true lateral facial cleft. The objective is to present two cases of macrostomia and perform a review of related literature. METHODS: In this study, we describe two cases of macrostomia treated with mucous flaps and zetaplasty. RESULTS: We obtained optimal repositioning of labial commissures in two patients, with excellent aesthetic results. CONCLUSION: The technique used is easily reproducible, and aesthetically and functionally corrects macrostomia.

Prevalence of patients with cleft lip and palate who were treated at the San Borja Arriarán Clinical Hospital in Santiago Chile, within the AUGE Healthcare Plan / Prevalencia de pacientes con fisuras labio palatinas tratadas en el Hospital San Borja Arriarán en Santiago de Chile, en el marco del Plan Auge

Cleft lip and palate (CLP) are congenital defects caused by faulty fusion of the embryonic processes that participate in the formation of oral and nasal cavities, this leads to a number of functional, social and psychological alterations. The incidence is estimated at 1/700 live birth, resulting in a high cost to the public health system. In 2005 these malformations were incorporated in the Regime of Explicit Health Guarantees (Garantías Explícitas en Salud ­ GES), also known as Plan AUGE, a health program developed in Chile, that has been conceived and implemented to guarantee access, quality, protection and recovery for certain pathologies. To determine which clefts are more prevalent in patients who were treated in the Hospital and compare these results are consistent with international literature, along with which gender is more affected and their association with other syndromes. Medical records of 169 patients with CLP were reviewed. Their gender, type of cleft according to its anatomical classification and their association with other syndromes were recorded. Ten percent of the CLP were associated with syndromes, there being a higher prevalence among male infants (56.8%) than females (43.2%). Incidence of cleft lip, with or without cleft palate, was higher than the incidence of isolated cleft palate. CLP has a heterogeneous distribution. This creates the need to know, which clefts are more prevalent in our patients and to compare with other results.

Las Fisuras Labio Palatinas (FLP) son defectos congénitos causados por una mala fusión de los procesos embrionarios que participan en la formación de las cavidades oral y nasal, que generan una seria de alteraciones funcionales, sociales y pscicológicas. La incidencia de las FLP se estima en 1/700 nacidos vivos, lo que genera un importante gasto a nivel de salud pública. En el 2005 éstas malformaciones fueron incorporadas al "Régimen de Garantías Explícitas en Salud (GES)", también conocido como Plan AUGE, éste es un programa de salud concebido y creado para garantizar el acceso, calidad, protección y recuperación de ciertas patologías. Determinar que fisuras con más prevalentes en pacientes que han sido tratados en el Hospital y comparar estos resultados con la literatura internacional, además determinar que género se ve más afectado y si existe asociación con síndromes. Se revisaron las fichas clínicas de 169 pacientes con FLP. Registrándose el género, el tipo FLP de acuerdo a su clasificación anatómica y la asociación con otros síndromes. Resultados: 10% de las FLP presentaban otro síndrome asociado. Hay una mayor incidencia en el género masculino (56,8%) que en el femenino (43.2%). Las fisuras de labio, con o sin compromiso del paladar, son más frecuentes que las fisuras labiales aisladas. Las FLP tienen una distribución heterogénea. Esto crea la necesidad de conocer que fisuras son más prevalentes en nuestros pacientes con el objetivo de compararlos con otros resultados.

Efeitos oclusais das expansões lenta e rápida da maxila nas fissuras completas bilaterais – estudo-piloto / Occlusal effects of slow and rapid maxillary expansions in complete bilateral cleft lip and palate – pilot study

O objetivo deste estudo-piloto foi comparar os efeitos oclusais das expansões lenta e rápida da maxila, em pacientes com fissuras labiopalatinas completas bilaterais. Um total de 30 indivíduos com fissuras labiopalatinas completas bilaterais, diagnosticados com constrição do arco dentário superior, foi aleatoriamente e igualmente dividido em dois grupos. O grupo ELM foi composto por pacientes submetidos à expansão lenta da maxila com quadri-hélice, enquanto que o grupo ERM consistiu de indivíduos submetidos à expansão rápida maxilar com Hyrax. Foram obtidos modelos de gesso nos períodos imediatamente pré-expansão e seis meses após a expansão, na ocasião da remoção do aparelho. Após a digitalização dos modelos de gesso superiores por meio do uso do scanner 3Shape R700 3D, foram mensurados a largura e o perímetro do arco dentário superior, e as inclinações dos dentes posterossuperiores através do programa de computador Orthoanalyzer. As comparações interfases e intergrupos foram avaliadas por meio do teste t pareado e do teste t de Student, respectivamente (p < 0,05). Ambas as modalidades de expansão provocaram aumentos significantes na largura e no perímetro do arco dentário superior. Apenas os caninos superiores de ambos os grupos apresentaram um aumento significante da inclinação vestibular. Não foram encontradas diferenças significantes entre os efeitos oclusais das duas modalidades de expansão maxilar. As expansões lenta e rápida da maxila parecem ser igualmente efetivas para a correção da constrição do arco dentário superior de pacientes com fissuras labiopalatinas completas bilaterais...

The aim of this pilot study was to compare the occlusal effects of slow and rapid maxillary expansions in patients with complete bilateral cleft lip and palate. Thirty individuals with complete bilateral cleft lip and palate diagnosed with maxillary dental arch constriction were equally and randomly divided into two groups. Group SME was comprised by patients who underwent slow maxillary expansion using Quad helix appliance, and Group RME was composed by individuals submitted to rapid maxillary expansion using Hyrax expander. Dental models were obtained immediately pre-expansion and 6 months after expansion, at the occasion of the appliance removal. After scanning the maxillary dental models using the 3Shape R700 3D scanner, the arch widths, the arch perimeter, and the buccolingual inclination of the maxillary posterior teeth were measured using Orthoanalyzer. The inter-phase and intergroup comparisons were performed using paired t test and Student’s t test, respectively (p < 0.05). Both expansion modalities have promoted significant increases in the maxillary dental arch widths and perimeter. Only the maxillary canines of both groups had a significant increase of the buccal inclination. No differences were found between the occlusal effects of both expansion modalities. Both slow and rapid maxillary expansions seem to be equally effective for the correction of maxillary dental arch constriction in patients with complete bilateral cleft lip and palate...

Adherencia al tratamiento del paciente con fisura labio-palatina (FLAP) 2006 - 2013 / Adherence to treatment of patients with cleft lip palate (FLAP) 2006-2013

Las Fisuras Labio Palatinas son anomalías congénitas que consisten en una hendidura o separación en el labio superior. Se presentan, frecuentemente, acompañadas de paladar hendido. El presente trabajo tiene por objetivo estudiar la complejidad y grado de adherencia, estudiando el grado de abandono en la rehabilitación del paciente FLAP que concurre a instituciones o servicios adheridos a la Red de Servicios / Instituciones de la Argentina. De un total de 749 pacientes fueron contactados aquellos con más de 200 días de inasistencia al servicio en un total de 162 (21,6%), de los cuales 55 (11,4%) manifestó abandono de tratamiento. El 46,8% de los pacientes no cuentan con cobertura por obra social / prepaga o mutual. El 18,2% posee certificado de discapacidad. El 47,8% de los pacientes requieren entre 1 a 2 horas de traslado para su atención, y el 27,3% más de 2 horas, a lo que se debe sumar los tiempos de espera en las instituciones. Del análisis de las variables seleccionadas se podría estimar que la edad, severidad de la lesión, número de convivientes en el domicilio y ausencia de certificado de discapacidad podrían ser utilizados como indicadores de posible abandono en el tratamiento.

Cleft lip palate is a congenital anomaly consisting of a crack or separation in the upper lip. It is often accompanied by cleft palate. The aims of the study it is to analyze the complexity and degree of rehabilitation adhesion, by abandonment analysis, of the FLAP patient who attends institutions or services belonging to the network of services / institutions in Argentina. A total of 749 patients were contacted those with more than 200 days of absenteeism to the service in a total of 162 (21,6%), of which 55 (11,4%) said abandonment of treatment. 46,8% of patients do not have coverage for work social/insurance/mutual. 18,2% possesses a certificate of disability. 47,8% of patients require between 1-2 hours of transfer for your attention, and 27,3% more than 2 hours, what to add the waiting time at the institutions. Analysis of selected variables you could estimate that the age, severity of injury, number of cohabitants in the domicile and absence of disability certificate could be used as indicators of possible abandonment in the treatment.

Acercamiento de los procesos alveolares mediante ortopedia prequirúrgica en pacientes con labio y paladar fisurado / Approaching of the alveolar processes using presurgical orthopedics in patients with cleft lip and palate

Las fisuras orales son un grupo heterogéneo de malformaciones congénitas de origen multifactorial. La fisura labio-palatina es una de las más frecuentes, producto de la alteración en la fusión de los procesos labiales mediales, laterales y palatinos durante el desarrollo embrionario, y Chile presenta una prevalencia mayor a la mundial. Su tratamiento contempla diversos procedimientos como la técnica prequirúrgica. El objetivo fue evaluar si el tratamiento prequirúrgico prepara a los pacientes con labio y/o paladar fisurado para la cirugía primaria. Se realizó un estudio retrospectivo, que incluyo a 100 pacientes de ambos sexos con fisura de labio y/o paladar atendidos bajo tratamiento de ortopedia prequirúrgica en el Consultorio Miraflores, Temuco, entre los años 2003 y 2012. Las fisuras fueron categorizadas según la clasificación de Kernahan. El 46% de los tratamientos logró un acercamiento adecuado para la cirugía y 20% sólo requirió manejo de tejidos blandos. Un 8% no logró un acercamiento adecuado. Veinticuatro porciento de los pacientes abandono el tratamiento. No se observaron diferencias entre la edad de inicio de tratamiento vs. acercamiento de los procesos alveolares. El manejo de tejidos blandos tuvo una correlación significativa con el tiempo total de tratamiento y el acercamiento de los procesos alveolares. Determinar la cantidad de pacientes que logran un acercamiento adecuado de los procesos alveolares mediante la técnica prequirúrgica, permite al clínico dimensionar el efecto del tratamiento y encontrar problemas que se puden estar presentando e impiden un mejor resultado

Oral clefts are a heterogeneous group of congenital malformations of multifactorial origin. Cleft lip and palate is one of the most frequent alterations of the fusion of the labial medial, lateral and palatal processes during embryonic development with Chile having a higher prevalence than the rest of the world. Treatment includes various procedures such as preoperative techniques. The objective of this study was to evaluate whether preoperative treatment prepares patients with cleft lip and/or cleft palate for primary surgery. We performed a retrospective study involving 100 male and female patients with cleft lip and/or palate admitted for presurgical orthopedic treatment at the Miraflores primary healthcare service, Temuco, Chile, between 2003 and 2012. Clefts were categorized according to Kernahan classification. Of the treatments, 46% achieved a suitable approach for surgery and 20% required only soft tissue management. Additionally, 8% percent did not achieve an adequate approach and twenty-four percent of patients discontinued therapy. No differences were observed between age at onset of treatment vs. alveolar process approach. Soft tissue management was significantly correlated with the total treatment time and the approach of the alveolar processes. To determine the number of patients achieving an adequate approach to the alveolar process by preoperative technique, allows the clinician to gauge the effect of treatment, find and prevent problems thereby obtaining better results