The korean journal of orthodontics (대한치과교정학회지)

The Korean Association Of Orthodontists (대한치과교정학회)
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Distribution, side involvement, phenotype and associated anomalies of Korean patients with craniofacial clefts from single university hospital-based data obtained during 1998-2018

  • Chung, Jee Hyeok (Department of Plastic and Reconstructive Surgery, Seoul National University Children's Hospital) ;
  • Yim, Sunjin (Department of Orthodontics, School of Dentistry, Seoul National University) ;
  • Cho, Il-Sik (Private Practice) ;
  • Lim, Seung-Weon (Department of Orthodontics, School of Dentistry, Chonnam National University) ;
  • Yang, Il-Hyung (Department of Orthodontics, Dental Research Institute, School of Dentistry, Seoul National University) ;
  • Ha, Jeong Hyun (Department of Plastic and Reconstructive Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center) ;
  • Kim, Sukwha (Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul National University) ;
  • Baek, Seung-Hak (Department of Orthodontics, Dental Research Institute, School of Dentistry, Seoul National University)
  • Received : 2020.04.14
  • Accepted : 2020.07.17
  • Published : 2020.11.30
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Abstract

Objective: To investigate the distribution, side involvement, phenotype, and associated anomalies of Korean patients with craniofacial clefts (CFC). Methods: The samples consisted of 38 CFC patients, who were treated at Seoul National University Dental Hospital during 1998-2018. The Tessier cleft type, sex, side involvement, phenotype, and associated anomalies were investigated using non-parametric statistical analysis. Results: The three most common types were #7 cleft, followed by #0 cleft and #14 cleft. There was no difference between the frequency of male and female. Patients with #0 cleft exhibited nasal deformity, bony defect, and missing teeth in the premaxilla, midline cleft lip, and eye problems. A patient with #3 cleft (unilateral type) exhibited bilateral cleft lip and alveolus. All patients with #4 cleft were the bilateral type, including a combination of #3 and #4 clefts, and had multiple missing teeth. A patient with #5 cleft (unilateral type) had a posterior openbite. In patients with #7 cleft, the unilateral type was more prevalent than the bilateral type (87.0% vs. 13.0%, p < 0.001). Sixteen patients showed hemifacial microsomia (HFM), Goldenhar syndrome, and unilateral cleft lip and palate (UCLP). There was a significant match in the side involvement of #7 cleft and HFM (87.5%, p < 0.01). Patients with #14 cleft had plagiocephaly, UCLP, or hyperterorbitism. A patient with #30 cleft exhibited tongue tie and missing tooth. Conclusions: Due to the diverse associated craniofacial anomalies in patients with CFC, a multidisciplinary approach involving a well-experienced cooperative team is mandatory for these patients.

Keywords

References

  1. Tobiasen JM, Levy J, Carpenter MA, Hiebert JM. Type of facial cleft, associated congenital malformations, and parents' ratings of school and conduct problems. Cleft Palate J 1987;24:209-15.
  2. Eppley BL, van Aalst JA, Robey A, Havlik RJ, Sadove AM. The spectrum of orofacial clefting. Plast Reconstr Surg 2005;115:101e-14e. https://doi.org/10.1097/01.PRS.0000164494.45986.91
  3. Wehby GL, Cassell CH. The impact of orofacial clefts on quality of life and healthcare use and costs. Oral Dis 2010;16:3-10. https://doi.org/10.1111/j.1601-0825.2009.01588.x
  4. Butow KW, Botha A. A classification and construction of congenital lateral facial clefts. J Craniomaxillofac Surg 2010;38:477-84. https://doi.org/10.1016/j.jcms.2010.02.007
  5. Racz C, Dakpe S, Kadlub N, Testelin S, Devauchelle B, Rachwalski M, et al. Phenotypic spectrum of Tessier facial cleft number 5. J Craniomaxillofac Surg 2018;6:22-7.
  6. David DJ, Moore MH, Cooter RD. Tessier clefts revisited with a third dimension. Cleft Palate J 1989;26:163-84; discussion 184-5.
  7. Fogh-Andersen P. Genetic and non-genetic factors in the etiology of facial clefts. Scand J Plast Reconstr Surg 1967;1:22-9. https://doi.org/10.3109/02844316709006555
  8. van der Meulen JC. Oblique facial clefts: pathology, etiology, and reconstruction. Plast Reconstr Surg 1985;76:212-24. https://doi.org/10.1097/00006534-198508000-00007
  9. Johnston MC. Embryology of head and neck. In: McCarthy JG, ed. Plastic surgery. Volume 4, cleft lip and palate and craniofacial anomalies. Philadelphia: Saunders; 1990. p. 2451-95.
  10. Murray JC. Face facts: genes, environment, and clefts. Am J Hum Genet 1995;57:227-32.
  11. Moore MH. Rare craniofacial clefts. J Craniofac Surg 1996;7:408-11. https://doi.org/10.1097/00001665-199611000-00003
  12. Bradley JP, Hurwitz DJ, Carstens MH. Embryology, classifications, and descriptions of craniofacial clefts. In: Mathes SJ, Hentz VR, eds. Plastic surgery. Vol. 4, pediatric plastic surgery. 2nd ed. Philadelphia: Saunders; 2006. p. 15-43.
  13. Kalantar-Hormozi A, Abbaszadeh-Kasbi A, Goravanchi F, Davai NR. Prevalence of rare craniofacial clefts. J Craniofac Surg 2017;28:e467-70. https://doi.org/10.1097/SCS.0000000000003771
  14. Kawamoto HK. Rare craniofacial clefts. In: McCarthy JG, ed. Plastic surgery. Philadelphia: W.B. Saunders; 1990. p. 389-550, 2952-5.
  15. Darzi MA, Chowdri NA. Oblique facial clefts: a report of Tessier numbers 3, 4, 5, and 9 clefts. Cleft Palate Craniofac J 1993;30:414-5. https://doi.org/10.1597/1545-1569_1993_030_0414_ofcaro_2.3.co_2
  16. Ozaki W, Kawamoto HK Jr. Craniofacial clefting. In: Lin KY, Ogle RC, Jane JA, eds. Craniofacial surgery: science and surgical technique. Philadelphia: W.B. Saunders; 2002. p. 309-31.
  17. da Silva Freitas R, Alonso N, Shin JH, Busato L, Ono MC, Cruz GA. Surgical correction of Tessier number 0 cleft. J Craniofac Surg 2008;19:1348-52. https://doi.org/10.1097/SCS.0b013e318184326e
  18. Spolyar JL, Hnatiuk M, Shaheen KW, Mertz JK, Handler LF, Jarial R, et al. Tessier No. 3 and No. 4 clefts: sequential treatment in infancy by pre-surgical orthopedic skeletal contraction, comprehensive reconstruction, and novel surgical lengthening of the ala base-canthal distance. J Craniomaxillofac Surg 2015;43:1261-8. https://doi.org/10.1016/j.jcms.2015.06.002
  19. Forbes BJ. Congenital craniofacial anomalies. Curr Opin Ophthalmol 2010;21:367-74. https://doi.org/10.1097/ICU.0b013e32833cd422
  20. Speltz ML, Richman L. Progress and limitations in the psychological study of craniofacial anomalies. J Pediatr Psychol 1997;22:433-8. https://doi.org/10.1093/jpepsy/22.4.433
  21. Kim SH, Jeon JY, Bae YC, Kim SS. A clinical study on the Tessier classification No.7 cleft patient. J Korean Soc Plast Reconstr Surg 1998;25:243-51.
  22. Baek RM, Kim YK. Median and paramedian craniofacial cleft. J Korean Soc Plast Reconstr Surg 2000;27:159-64.
  23. Son HD, Oh K, Lee KC, Park JM, Kim JT, Kim SK. Clincal Experience of the median mandibular facial cleft. J Korean Cleft Palate-Craniofac Assoc 2001;2:139-42.
  24. Lee JH, Lee KC, Park JM, Kim SK. Postoperative analysis of the Tessier classification No.7 cleft patient. J Korean Cleft Palate-Craniofac Assoc 2004;5:24-30.
  25. Park YT, Kye JY, Kim SG, Kwon KJ, Park YW. Tessier No. 2 oblique facial cleft not associated with cleft lip or palate: a case report. J Korean Assoc Maxillofac Plast Reconstr Surg 2010;32:600-3.
  26. Bae YC, Kang KD, Kim KH. Alteration in surgical technique of Tessier classification number 7 cleft. Arch Plast Surg 2011;38:143-7.
  27. Nam SM, Kim YB. The Tessier number 14 facial cleft: a 20 years follow-up. J Craniomaxillofac Surg 2014;42:1397-401. https://doi.org/10.1016/j.jcms.2014.03.032
  28. Baek SH, Park YH, Chung JH, Kim S, Choi JY. Orthodontic and orthopedic treatment for a growing patient with Tessier number 0 cleft. Korean J Orthod 2018;48:113-24. https://doi.org/10.4041/kjod.2018.48.2.113
  29. Oh JH, Park YW. Anatomical repair of a bilateral Tessier No. 3 cleft by midfacial advancement. Maxillofac Plast Reconstr Surg 2018;40:9. https://doi.org/10.1186/s40902-018-0147-3
  30. Ryu JY, Eo PS, Tian L, Lee JS, Lee JW, Choi KY, et al. Surgical correction for Tessier number 7 craniofacial cleft using a medially overcorrected design. Arch Plast Surg 2019;46:16-22. https://doi.org/10.5999/aps.2018.01193
  31. van der Meulen JC, Mazzola R, Vermey-Keers C, Stricker M, Raphael B. A morphogenetic classification of craniofacial malformations. Plast Reconstr Surg 1983;71:560-72. https://doi.org/10.1097/00006534-198304000-00022
  32. Portier-Marret N, Hohlfeld J, Hamedani M, de Buys Roessingh AS. Complete bilateral facial cleft (Tessier 4) with corneal staphyloma: a rare association. J Pediatr Surg 2008;43:e15-8.
  33. Alonso N, Freitas Rda S, de Oliveira e Cruz GA, Goldenberg D, Dall'oglio Tolazzi AR. Tessier no. 4 facial cleft: evolution of surgical treatment in a large series of patients. Plast Reconstr Surg 2008;122:1505-13. https://doi.org/10.1097/PRS.0b013e318188209c
  34. Kuriyama M, Udagawa A, Yoshimoto S, Ichinose M, Suzuki H. Tessier number 7 cleft with oblique clefts of bilateral soft palates and rare symmetric structure of zygomatic arch. J Plast Reconstr aesthet Surg 2008;61:447-50. https://doi.org/10.1016/j.bjps.2006.05.019
  35. Mishra RK, Purwar R. Formatting the surgical management of Tessier cleft types 3 and 4. Indian J Plast Surg 2009;42 Suppl(Suppl):S174-83. https://doi.org/10.1055/s-0039-1699391
  36. da Silva Freitas R, Alonso N, Shin JH, Busato L, Dall'Oglio Tolazzi AR, de Oliveria e Cruz GA. The Tessier number 5 facial cleft: surgical strategies and outcomes in six patients. Cleft Palate Craniofac J 2009;46:179-86. https://doi.org/10.1597/07-192.1
  37. Tessier P. Anatomical classification facial, craniofacial and latero-facial clefts. J Maxillofac Surg 1976;4:69-92. https://doi.org/10.1016/S0301-0503(76)80013-6
  38. Woods RH, Varma S, David DJ. Tessier no. 7 cleft: a new subclassification and management protocol. Plast Reconstr Surg 2008;122:898-905. https://doi.org/10.1097/PRS.0b013e3181811cb6
  39. Cheung LK, Samman N, Tideman H. Bilateral transverse facial clefts and accessory maxillae--variant or separate entity? J Craniomaxillofac Surg 1993;21:163-7. https://doi.org/10.1016/S1010-5182(05)80106-4