Orthodontic burden of care for patients with a cleft lip and/or palate.

BACKGROUND: Patients with a cleft lip and/or palate may require multiple episodes of orthodontic treatment, e.g. before alveolar bone grafting, upper arch alignment, orthodontic camouflage and in combination with orthognathic surgery. There is little published regarding the overall orthodontic burden of care for these patients. AIM: To assess the orthodontic burden of care for patients with a cleft lip and/or palate. METHOD: Data were collected retrospectively from all consecutive cleft patients who had completed orthodontic treatment between January 2014 and December 2015 at Great Ormond Street Hospital, London, United Kingdom. RESULTS: Forty-two patients were included in the study: Twenty-three patients with a cleft lip and palate; nine with an isolated cleft palate; eight with cleft lip and alveolus; and two with cleft lip. The mean age of orthodontic treatment commencement was 13.4 years (range = 8.9-18.2 years) with a mean duration of 3.4 years (range = 1.3-8.3 years). An average of 44 appointments were required with an orthodontist (range = 18-98 appointments). CONCLUSION: The orthodontic burden of care for patients with cleft lip and/or palate must not be underestimated. The duration of treatment varies depending on the type of cleft diagnosis and whether orthognathic surgery will be required. From this study, a patient with cleft lip and/or palate required an average of 44 orthodontic appointments and a mean duration of treatment of 3.4 years in order to complete their treatment. This is a considerable burden to patients and their guardians, which they must be informed of before commencement of orthodontic treatment.

Maxillary Growth in Cleft Lip and Palate Patients, With and Without Vomerine Flap Closure of the Hard Palate at the Time of Lip Repair: A Retrospective Analysis of Prospectively Collected Nonrandomized Data, With 10-Year Cephalometric Outcomes.

OBJECTIVE: To assess the midterm effect on maxillary growth of vomerine flap (VF) closure of the hard palate, at the time of lip repair. DESIGN: A retrospective analysis of prospectively collected nonrandomized data. INTERVENTIONS: Consecutive participants with a unilateral cleft lip and palate (UCLP) were operated on, at 3 months of age, by the same surgeon. They were divided into 2 groups, those who had a VF and those who did not (non-VF). SETTING: Participants were treated at 2 hospitals in the United Kingdom. PARTICIPANTS: Twenty-eight participants in the VF group and 24 participants in the non-VF group attended follow-up at 10 years of age. MAIN OUTCOME MEASURES: Standardized lateral cephalometric radiographs were taken at 10 years. Following tracing and digitization, parameters to assess the maxillary growth were analyzed. RESULTS: No statistically significant differences were found in the anterior-posterior or vertical skeletal cephalometric parameters. CONCLUSIONS: The results of this study support the statement that VF repair does not significantly affect maxillary growth in patients with a UCLP, when assessed cephalometrically at 10 years of age. It should be noted that at this age, growth is not yet complete.

Ready-Made Versus Custom-Made Mandibular Repositioning Devices in Sleep Apnea: A Randomized Clinical Trial.

STUDY OBJECTIVES: To compare the effectiveness of a custom-made (MRDc) versus ready-made (MRDr) mandibular repositioning devices (MRD) in the management of obstructive sleep apnea (OSA). METHODS: A randomized crossover trial design was adopted in which patients with a confirmed diagnosis of OSA were randomly allocated to receive either a 3-month period of ready-made or custom-made MRD, with an intervening washout period of 2 weeks, prior to crossover. Treatment outcomes included both objective sleep monitoring and patient-centered measures (daytime sleepiness, partner snoring and quality of life). RESULTS: Twenty-five patients, with a mild degree of OSA (apnea-hypopnea index of 13.3 [10.9-25] events/h) and daytime sleepiness (Epworth Sleepiness Scale of 11 [6-16]), completed both arms of the trial. The MRDc achieved a complete treatment response in 64% of participants, compared with 24% with the MRDr (p < 0.001). A significant difference was observed in treatment failures, when comparing the MRDr (36%) with the MRDc (4%). Excessive daytime sleepiness (Epworth Sleepiness Scale ≥ 10) persisted in 33% (MRDc) and 66% (MRDr) of OSA subjects, following treatment. A statistically significant improvement was observed in quality of life scales following MRDc therapy only. Significant differences were observed in relation to both the number of nights per week (p = 0.004) and hours per night (p = 0.006) between the two different designs of device. CONCLUSIONS: The study demonstrates the significant clinical effectiveness of a custom-made mandibular repositioning device, particularly in terms of patient compliance and tolerance, in the treatment of OSA.