One-stage (Warsaw) and two-stage (Oslo) repair of unilateral cleft lip and palate: Craniofacial outcomes.

The aim of this study was to compare facial development in subjects with complete unilateral cleft lip and palate (CUCLP) treated with two different surgical protocols. Lateral cephalometric radiographs of 61 patients (42 boys, 19 girls; mean age, 10.9 years; SD, 1) treated consecutively in Warsaw with one-stage repair and 61 age-matched and sex-matched patients treated in Oslo with two-stage surgery were selected to evaluate craniofacial morphology. On each radiograph 13 angular and two ratio variables were measured in order to describe hard and soft tissues of the facial region. The analysis showed that differences between the groups were limited to hard tissues ­ the maxillary prominence in subjects from the Warsaw group was decreased by almost 4° in comparison with the Oslo group (sella-nasion-A-point (SNA) = 75.3° and 79.1°, respectively) and maxillo-mandibular morphology was less favorable in the Warsaw group than the Oslo group (ANB angle = 0.8° and 2.8°, respectively). The soft tissue contour was comparable in both groups. In conclusion, inter-group differences suggest a more favorable outcome in the Oslo group. However, the distinctiveness of facial morphology in background populations (ie, in Poles and Norwegians) could have contributed to the observed results.

Speech outcomes in 10-year-old children with complete unilateral cleft lip and palate after one-stage lip and palate repair in the first year of life.

An evaluation of the results of one-stage repair of unilateral cleft lip and palate (UCLP) performed at the Institute of Mother and Child, Warsaw, Poland, has shown that the dentofacial outcomes are comparable with those of the best cleft centres. The aim of this study was to assess speech development after one-stage closure of UCLP. Twenty boys and eight girls at the mean age 9.6 years consecutively treated with one-stage closure of the cleft at the mean age of 8.8 (range, 6-13) months were included. The same surgeon performed palatal repair using a vomerplasty. The evaluated outcomes included (1) perceptual speech evaluations with assessment of hypernasality, audible nasal emissions (ANEs) and compensatory articulations, (2) evaluation of compensatory facial grimacing, (3) clinical intraoral evaluation and (4) videonasendoscopy when indicated. Our results demonstrated that 25 patients (89.3%) had normal nasal resonance. Severe hypernasality and compensatory articulation disorders caused by velopharyngeal insufficiency were assessed in one patient. In 13 patients (46.4%), oronasal fistulas were found. Two children (7%) with larger fistulas presented with mild hypernasality. In 11 cases (39.2%), fistula friction was heard at pronunciation of some anterior sounds. Ten children (35.7%) demonstrated compensatory facial grimacing, mostly inconsistent and mild, in the form of nasal valving. In conclusion, articulation development, velopharyngeal sphincter competence and incidence of compensatory articulations in our sample are satisfactory. However, only 54% of the present groups were rated as having entirely normal speech because of high incidences of anterior palatal fistulas, and mild but frequent fistula-related speech disturbances.

Palate dimensions in six-year-old children with unilateral cleft lip and palate: a six-center study on dental casts.

OBJECTIVE: To compare palatal dimensions in 6-year-old children with unilateral cleft lip and palate (UCLP) treated by different protocols with those of noncleft children. DESIGN: Retrospective intercenter outcome study. Patients : Upper dental casts from 129 children with repaired UCLP and 30 controls were analyzed by the trigonometric method. SETTING: Six European cleft centers. Main outcome measures : Sagittal, transverse, and vertical dimensions of the palate were observed. STATISTICS: Palate variables were analyzed with descriptive methods and nonparametric tests. Regarding several various characteristics measured on a relatively small number of subjects, hierarchical, k-means clustering, and principal component analyses were used. RESULTS: Mean values of the observed dimensions for five cleft groups differed significantly from the control (p < .05). The group with one-stage closure of the cleft differed significantly from all other cleft groups in most variables (p < .05). Principal component analysis of all 159 cases identified three clusters with specific morphologic characteristics of the palate. A similar number of treated children were classified into each cluster, while all children without clefts were classified in the same cluster. The percentage of treated children from a particular group that fit this cluster ranged from 0% to 70% and increased with age at palatal closure and number of primary surgical procedures. CONCLUSION: At 6 years of age, children with stepwise repair and hard palate closure after the age of two more frequently result in palatal dimensions of noncleft control than children with earlier palatal closure and one-stage cleft repair.

Dental arch relationship in children with complete unilateral cleft lip and palate following Warsaw (one-stage repair) and Oslo protocols.

OBJECTIVE: To compare the dental arch relationship following one-stage repair of unilateral cleft lip and palate (UCLP) in Warsaw with a matched sample of patients treated by the Oslo Cleft Team. MATERIAL: Study models of 61 children (mean age, 11.2; SD, 1.7) with a nonsyndromic complete UCLP consecutively treated with one-stage closure of the cleft at 9.2 months (range, 6.0 to 15.8 months; SD, 2.0) by the Warsaw Cleft Team at the Institute of Mother and Child, Poland, were compared with a sample drawn from a consecutive series of patients with UCLP treated by the Oslo Cleft Team and matched for age, gender, and soft tissue band. METHODS: The study models were given random numbers to blind their origin. Four examiners rated the dental arch relationship using the GOSLON Yardstick. The strength of agreement of rating was assessed with weighted Kappa statistics. An independent t-test was carried out to compare the GOSLON scores between Warsaw and Oslo samples, and Fisher's exact tests were performed to evaluate the difference of distribution of the GOSLON scores. RESULTS: The intrarater and interrater agreements were high (K > or = .800). No difference in dental arch relationship between Warsaw and Oslo groups was found (mean GOSLON score = 2.68 and 2.65 for Warsaw and Oslo samples, respectively). The distribution of the GOSLON grades was similar in both groups. CONCLUSIONS: The dental arch relationship following one-stage repair (Warsaw protocol) was comparable with the outcome of the Oslo Cleft Team's protocol.

Treatment outcome after one-stage repair in children with complete unilateral cleft lip and palate assessed with the Goslon Yardstick.

OBJECTIVE: To compare results of Golson Yardstick measurement of dental arch relationships in a sample of 10-year-old Polish children with results of the Golson measurement in published reports. MATERIALS AND METHODS: Plaster models of 28 consecutively treated subjects with unilateral cleft lip and palate (UCLP) that was repaired with a one-stage simultaneous closure performed in the first year of life. All individuals were born between 1994 and 1995. The Goslon score (categories 1 to 5) was allocated. Intra- and interrater agreement was assessed with kappa statistics and Pearson correlation coefficient. Independent t tests were employed to detect difference between the score in the present and other published samples. RESULTS: Mean Goslon score equaled 2.44; 57% of the patients were allocated Goslon category 1 or 2, 32% were rated Goslon 3, and 11% of the patients were assigned category 4 or 5. Intrarater agreement was between 0.75 and 0.77. Interrater agreement was 0.79. CONCLUSIONS: Dental arch relationship following one-stage repair was comparable with the results of the centers with the best outcome.

Mandibular morphology and spatial position following one-stage simultaneous repair of complete unilateral cleft lip and palate.

OBJECTIVE: To assess mandibular structure and spatial position following one-stage simultaneous repair of the unilateral cleft lip and palate. DESIGN: Forty boys and 17 girls with complete unilateral cleft lip and palate who underwent one-stage simultaneous repair of the cleft by the same surgeon at the age of 9.23 months (standard deviation = 1.74) were selected. Lateral cephalograms taken at the age of approximately 10 years were analyzed and were compared with a sex- and age-matched control group that consisted of individuals with Angle Class I, no crossbite, positive overbite <5 mm, mild crowding (Incisor Irregularity Index <3.5 mm), and harmonious facial build. RESULTS: No intergroup differences were demonstrated regarding structure of the cranial base. The mandible was found to be retruded and at a larger inclination to the cranial base as compared with controls. Both total mandibular length (ArGn) and length of the mandibular body were larger in the control group, at <2 mm. Height of the ramus and gonial angle were similar in both groups. Intergender comparison showed few significant differences in control subjects only (SN, SGo, and NMe variables). CONCLUSIONS: The mandible, following a one-stage simultaneous repair of cleft, was found to be retrusive, and the length of mandibular body was <2 mm shorter than that of the controls.

[Distraction osteogenesis in the treatment of hemifacial microsomia]. / Zastosowanie osteogenezy dystrakcyjnej w leczeniu polowiczego niedorozwoju twarzy na podstawie badan wlasnych.

PURPOSE: This report presents the results of distraction osteogenesis using an extra oral device in 28 patients with different grade of vertical mandibular ramus hypoplasia. MATERIAL AND METHOD: 28 patients (aged 2 to 15 years) with hemifacial microsomia underwent unilateral lengthening of the ascending ramus using unidirectional extraoral devices (Molina distractor). 3D-CT and cephalometric radiographs were analysed to determine the placement of the mandibular osteotomy and select the appropriate placement of the distraction device. RESULT: On the basis of one-year follow-up we can conclude that excellent, stable and functional mandibular lengthening was achieved with external distraction osteogenesis with minimal complications in all our patients. Coordinated growth between maxillary and mandibular arches with stable occlusion is observed. CONCLUSION: Mandibular distraction osteogenesis has proved to be an excellent technique for the treatment of mandibular deficiency. Careful and comprehensive planning of treatment, coupled with control of the distraction vector can bring about predictable results with minimal morbidity. Nevertheless. It is our conclusion that good and effective orthodontics within the period of consolidation is the key to achieve satisfactory stability results.