Is the Nasolabial Region Symmetric in Individuals With Cleft Lip and Palate?

OBJECTIVE: To assess the nasolabial symmetry in smile and resting position in individuals with nonsyndromic unilateral cleft lip and palate (UCLP) and compare with Class I individuals without cleft lip and palate (CLP). MATERIALS AND METHODS: Frontal photographs of 40 individuals with UCLP (mean age 14.30 ± 0.25 years; 20 female, 20 male) and 40 skeletal Class I individuals without CLP (mean age 14.60 ± 0.34 years; 20 female and 20 male) were examined. Bland-Altman Levels of Agreements, Mann-Whitney U test, independent sample t-test were conducted, and intraclass correlation coefficients (ICCs) were calculated for statistical analysis. RESULTS: Differences in the transverse lip distance (d-d') and vertical lip height at crista philtri (e-e') were lesser in the UCLP group at smile (P = .001; P = .005, respectively). When comparing the differences in these measurements at rest between control and UCLP groups, vertical lip height was longer at crista philtri (e-e') (P = .014), crista philtri was more laterally located (f-f') (P = .002), and the transverse lip distance was greater (d-d') (P = .004) in the UCLP group. Distance of the crista philtri to the midline of the face (f-f') (P = .007) were higher in the UCLP group during smiling compared to control group. CONCLUSIONS: Nasolabial region asymmetry in smiling and rest position in individuals with UCLP was significantly different from the control group. However, the asymmetry in the nasolabial region, which is more evident in the resting position in individuals with UCLP, decreases during smiling.

Relationship between disease awareness and severity of kidney disease in autosomal dominant polycystic kidney disease patients.

INTRODUCTION: Polycystic kidney disease (PKD) is responsible for 5%-10% of end-stage renal disease. We examined the relationship between renal and extrarenal findings, disease severity, and the level of consciousness of PKD patients. METHODS: Patients were asked to answer the questionnaire about PKD. Disease severity was determined according to estimated glomerular filtration rate, and disease awareness was assessed by adapting the Disease Perception Scale to PKD. Awareness of patients was evaluated comparatively with chronic kidney disease stage, age, region, and symptoms. RESULTS: One out of five patients does not know that this disease is inherited. Mean awareness scores of the patients decreased significantly with increasing age. Awareness scores were significantly higher in patients with flank pain, hematuria, and urinary tract stones. CONCLUSION: Although PKD is the most common hereditary kidney disease, the rate of patients' knowledge on this subject is low. Increased awareness might lead to better treatment in those patients.

Maxillary Development in Patients with Unilateral Cleft Lip and Palate Compared with Individuals Having Skeletal Class I and Class III Malocclusion.

AIM: To compare maxillary development of individuals with unilateral cleft lip and palate (CLP) to individuals with skeletal Class I and Class III malocclusions. STUDY DESIGN: Cephalometric X-ray films from 90 patients (mean age: 13 ± 2.3 years) were used. The number of samples was determined by Power analysis and three groups consisting of 30 patients (Group 1: Skeletal Class I, Group 2: Skeletal Class III, Group 3: CLP) were formed. A total of 13 cephalometric measurements were performed using Dolphin imaging software 11.7. The Kruskal-Wallis and ANOVA tests were used to calculate the differences. The Dunn test and Bonferroni correction were used in paired group comparisons. RESULTS: SNA, Co-A, A-PTV Horizontal, Na-APog, A-Na-Pog, FH-NA, Sn'-Mx1, MxOP-TVL (p<0.001***), U6-PTV Vertical (p<0.01**), and NaBa PTV-Gn (p<0.05*) values were significantly different between the three groups. There was no significant difference in Na-ANS, FH-NPog, or Mx1 labial-ULA. SNA, Co-A, A-PTV Horizontal, Na-APog, and A-Na-Pog values between the 1st and 2nd groups and between the 1st and 3rd groups (p<0.001***) were significantly different. FH-Na-A, Sn'-Mx1, MxOP-TVL (p<0.001***), and U6-PTV vertical were different between groups 1 and 3 (p<0.01**), while FH-Na-A (p<0.001***), Sn'-Mx1, MxOP-TVL (p<0.01**), A-PTV Horizontal, and A-Na-Pog (p<0.05*) were significantly different between groups 2 and 3. CONCLUSION: Maxillary development in CLP differs from skeletal Class I but is similar to skeletal Class III. Considering the delay in maxillary development in the CLP patient, maxillary protraction and maxillary expansion are important treatment protocols in the early period.

Evaluation of the cervical vertebral anomalies in patients with cleft lip and palate in Aegean region of Turkey.

OBJECTIVE: To identify the cervical vertebral anomalies in patients with cleft lip and palate, and to compare unilateral and bilateral cleft lip and palate. METHODS: The retrospective cohort study was conducted in 2018 at Department of Orthodontics, Ege University, Izmir, Turkey, and comprised non-deteriorated lateral cephalometric radiographs of non-syndromic patients which showed the entire cervical spine. The radiographs were divided into two groups, with group A having those of patients with cleft lip and palate exposure, and control group B having those with non-exposure. Within group A, unilateral and bilateral cleft lip and palate cases were compared. Data was analysed using SPSS 22. RESULTS: Of the 220 subjects, 110(50%) were in group A with a mean age of 15±6.3 years, and 110(50%) were in group B with a mean age of 15±2.1 years. Within group A, 56(50.9%) subjects had unilateral and 54(49.1%) had bilateral cleft lip and palate. Cervical vertebral anomalies were found in 71(64.5%) patients and 45(40.9%) controls (p<0.001). Among those with bilateral condition, it was found in 41(75.9%) and in unilateral 56(56.6%) (p<0.05). Occipitalisation was 21(38.9%) in bilateral and 4(7.1%) in unilateral cases (p<0.001). Fusion was higher in bilateral patients 16(63%) compared to 23(41.1%) unilateral (p<0.05). Posterior arch deficiencies were found in 30(27.3%) patients in group A and 18(16.4%) controls in group B (p<0.05). Fusion was seen in 57(51.8%) group A patients and 33(30%) group B controls (p<0.001). CONCLUSIONS: Cervical vertebral anomalies were mostly found in patients with cleft lip and palate. In patients with bilateral condition, more than one anomaly was seen.

Maxillary protraction in patients with unilateral cleft lip and palate : Evaluation of soft and hard tissues using the Alt-RAMEC protocol.

PURPOSE: The aim of this study was to evaluate the hard and soft tissue effects and differences of the Alt-RAMEC protocol to the facemask and conventional facemask protocols in patients with unilateral cleft lip and palate. METHODS: This prospective study was carried out with 30 patients with unilateral cleft lip and palate with skeletal and dental class III malocclusions who were referred to a university department of orthodontics. The patients were evaluated with the cervical vertebral maturation method and divided into two groups, each consisting of 15 patients. The patients in group I (mean age 10.00 ± 0.73 years) were treated according to conventional facemask protocol, and the patients in group II (mean age 10.07 ± 2.43 years) were treated according to the Alt-RAMEC protocol before facemask application. Lateral cephalometric radiographs were evaluated by using the Dolphin Imaging Software version 11.7. The skeletal, dentoalveolar and soft tissue differences and treatment times were evaluated. RESULTS: Group II demonstrated a 5.73° increase in SNA, which was statistically significant, while this increase was 3.13° in group I (p < 0.001). Results for Co­A and A­PTV showed a significant increase for group II only (group I: 1.02 mm, 1.06 mm, group II: 3.02 mm, 2.21 mm; p < 0.05 and p < 0.01, respectively). In addition, group II presented significant increase for the values of ANB, N­A-Pg, SN/MP, Wits, U1-SN, U1-L1, U1-PTV, U1-FHP, U6-PTV, U6-FHP, overjet, Ss-PTV, UL-PTV and UL­S line (p < 0.001). The treatment mean times were 7.3 months in group I and 4.7 months in group II (p < 0.01). CONCLUSION: Applying the facemask after having followed the Alt-RAMEC protocol induced more skeletal, dentoalveolar and soft tissue changes in comparison to the conventional facemask protocol in patients with unilateral cleft lip and palate.

Visual perception of faces with unilateral and bilateral cleft lip and palate: An Eye-Tracking Study.

OBJECTIVES: To test the hypotheses that there are differences between orthodontists, individuals with cleft lip and palate (CLP) and laypersons in the visual perception of faces with unilateral (UCLP) and bilateral cleft lip and palate (BCLP), the faces with UCLP and BCLP are visually perceived differently and the hierarchy of visual attention changes when viewing individuals with CLP. SETTING AND SAMPLE POPULATION: Department of Orthodontics and Experimental Psychology at Ege University, Izmir. Sixty images (faces with a social smile and at rest) of 30 volunteers (unaffected controls, UCLP, BCLP) were viewed by 80 participants: orthodontists, individuals with CLP and laypersons. MATERIALS AND METHODS: Eye fixations on four areas of interest were quantified: eyes, nose, upper lip and lower lip-chin. Time to first fixation, fixation before, fixation count and fixation duration parameters were analysed. RESULTS: Orthodontists fixated on the upper-lip area more often than laypersons or individuals with CLP (F2.144 =8.47, P=.00, η²=.19 in faces at rest). The upper-lip area received more fixations (F2.144 =21.93, P=.00, η²=.23) and longer fixation durations (F2.144 =28.86, P=.00, η²=.27) from all participants who gazed on faces with UCLP and a social smile. CONCLUSION: The hypotheses of the study were supported. Orthodontists and laypersons focused more attention on the upper lip and eyes in the resting position, respectively. The upper-lip area of the BCLP images captured more attention at rest.