• Title/Summary/Keyword: Cleft and Craniofacial Patients

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A National Survey for Korean Orthodontic Residents about a Present Condition in Management and Training Program for Cleft and Craniofacial Patients (구순구개열 및 두개안면기형 환자의 진료 및 교육현황에 관하여 치과교정과 전공의를 대상으로 한 기초설문 조사 결과)

  • Seo, Yu-Jin;Cho, Il-Sik;Baek, Seung-Hak
    • Korean Journal of Cleft Lip And Palate
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    • v.15 no.1
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    • pp.11-20
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    • 2012
  • A national wide survey was conducted to assess a present condition in management of cleft and craniofacial anomaly patients and training program of orthodontic residents in Korea. A questionnaire consisting of four categories and 19 question items was distributed to 131 residents of department of orthodontics of eleven dental university hospitals and nine medical university hospitals. The results were as follows:(1) 77.1% of residents are participating in treatment of cleft and craniofacial anomaly patients.(2) Only 47.3% of residents are willing to treat cleft and craniofacial anomaly patients in their future practice.(3) 64.9% of residents responded that they are currently treating one to ten cleft and craniofacial anomaly patients per resident.(4) Most university hospitals offer training programs focusing on embryopathogenesis, growth, and treatment, but training programs about speech and hearing, genetics, and psychosocial development are inadequate.(5) 37.4% of residents are willing to participate in fellowship program for cleft and craniofacial anomaly after finishing the training. Based on the results of this survey, the residents need motivation regarding treatment of cleft and craniofacial anomaly patients, and the educational programs need to be reinforced and reconstructed so that standardization among hospitals can be achieved.

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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;Yim, Sunjin;Cho, Il-Sik;Lim, Seung-Weon;Yang, Il-Hyung;Ha, Jeong Hyun;Kim, Sukwha;Baek, Seung-Hak
    • The korean journal of orthodontics
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    • v.50 no.6
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    • pp.383-390
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    • 2020
  • 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.

Craniofacial Centre of Children's Hospital Boston and Sequential Management for Cleft Lip and Palate (Children's Hospital Boston의 Craniofacial Centre와 구순구개열 환자의 순차적 치료순서)

  • Jung, Young-Soo
    • Korean Journal of Cleft Lip And Palate
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    • v.11 no.2
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    • pp.59-63
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    • 2008
  • Craniofacial Centre at Children's Hospital Boston is a worldwide leader in the care of children and adolescents with craniofacial anomalies especially with cleft lip and/or cleft palate, which provides a team approach to the evaluation, diagnosis and treatment of children and adults with congenital (present at birth) or acquired facial deformities. This is staffed by an experienced team of clinicians, such as in oral and maxillofacial surgery, plastic surgery, neurosurgery, dentistry, audiology, speech and language pathology, genetics, psychiatry, otolaryngology, and social work, all with specialized training in the care of children with craniofacial anomalies. Here, there is a short introduction of history, attending surgeons, works, and sequential treatment for cleft lip/palate patients about this institution.

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Somatosensory evoked potentials are abnormal with plagiocephaly

  • Harma, Maiju;Lauronen, Leena;Leikola, Junnu;Hukki, Jyri;Saarikko, Anne
    • Archives of Craniofacial Surgery
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    • v.23 no.2
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    • pp.59-63
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    • 2022
  • Background: Deformational plagiocephaly is usually managed conservatively, as it tends to improve over time and with the use of conservative measures. However, before the year 2017 we operated on patients with severe plagiocephaly and neurological symptoms at the Helsinki Cleft Palate and Craniofacial Center. Methods: Of the 20 infants with severe deformational plagiocephaly and neurological symptoms referred to us between 2014 and 2016, 10 underwent cranioplasty open reshaping of the posterior cranial vault. The parents of the last 10 patients were given information on the natural history of the condition and the patients were followed up with an outpatient protocol. The aim of this study was to gain information on the brain electrophysiology and recovery of patients after total cranial vault reconstruction by measuring the electroencephalogram (EEG) somatosensory evoked potentials (SEP; median nerve). Results: Of the 10 participants in the operation arm, six had abnormal SEP at least on the affected cerebral hemisphere and all SEPs were recorded as normal when controlled postoperatively. In the follow-up arm, eight out of 10 participants had abnormal SEP at the age of approximately 24 months, and all had normalized SEPs at control visits. Conclusion: Our data suggest that cranioplasty open reshaping of the posterior cranial vault did not affect abnormal SEP-EEG recordings. We have abandoned the operations in deformational plagiocephaly patients due to findings suggesting that expanding cranioplasty is not beneficial for brain function in this patient group.

Various craniofacial clefts (다양한 두개안면 파열)

  • Baek Seung-Hak;Lee Jin-Kyung;Kim Na-Young;Kim Tae-Kyung
    • Korean Journal of Cleft Lip And Palate
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    • v.6 no.2
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    • pp.117-130
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    • 2003
  • The prevalence of craniofacial cleft is reported to be 10-34 / 100,000 live birth of human. This case report describes the characteristics of the Tessier classification number 0, 5, 7, and 14 craniofacial cleft patients. Given the rarity and unique nature of the clinical expression of each of the craniofacial clefts, the treatment plans can not be standardized but must be based on the individual assessment of each case.

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Speech Evaluation Based on the Type of Cleft Palate (구개열의 유형에 따른 발음 비교)

  • Kim, Seok-Kwun;Kim, Min-Su;Heo, Jung;Kwon, Yong-Seok;Lee, Keun-Cheol;Jeong, Boon-Seon;Lee, Min Hyuk
    • Archives of Craniofacial Surgery
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    • v.9 no.2
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    • pp.72-76
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    • 2008
  • Purpose: Authors evaluated results of palatoplasty by speech analysis in bilateral, unilateral complete, and unilateral incomplete and submucous cleft palate patients. Methods: The speech outcomes were studied in 15 bilateral, 28 unilateral complete, and 46 unilateral incomplete and submucous cleft palate patients who underwent push-back palatoplasties from January 1998 to July 2004. The patients were divided into 2 groups as 3 to 6, 7 to 10-year-old and compared with 20 normal children(control groups were divided into 10 children on each side). Nasal emission test, hypernasality test, and articulation test were done by speech evaluation table which was composed of 39 different words. Results: In all speech evaluation tests, the group of bilateral cleft palate patients got the worst score. And 7 to 10-year-old groups got better score when compared to the same type cleft palate. Conclusion: Bilateral cleft palate patients have many more speech problems than other patients. In cleft palate patients, the speech problem was improved with ages, postoperatively. And the speech therapy can improve the operative outcomes.

Surgical correction for Tessier number 7 craniofacial cleft using a medially overcorrected design

  • Ryu, Jeong Yeop;Eo, Pil Seon;Tian, Lulu;Lee, Joon Seok;Lee, Jeong Woo;Choi, Kang Young;Yang, Jung Dug;Chung, Ho Yun;Cho, Byung Chae
    • Archives of Plastic Surgery
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    • v.46 no.1
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    • pp.16-22
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    • 2019
  • Background Various surgical techniques have been used to correct Tessier number 7 craniofacial cleft, which involves macrostomia, ear deformity, and hemifacial microsomia. To achieve symmetrical and satisfactory results in patients with macrostomia, the authors performed a 1-mm medial overcorrection on the cleft side and evaluated the results of this procedure. Methods A retrospective medical record review of patients diagnosed with Tessier number 7 craniofacial cleft from March 1999 to February 2017 was performed. Using clinical photographs, outpatient clinic records, and operative records, information was recorded regarding concurrent congenital anomalies, postoperative complications, and follow-up. Using Photoshop CS2, the length of both sides of the lip was compared. The ratio of these lengths was calculated to evaluate lip symmetry. Results Of the patients treated at the Department of Plastic and Reconstructive Surgery at Kyungpook National University Chilgok Hospital, 11 (male-to-female sex ratio, 7:4) were diagnosed with Tessier number 7 craniofacial cleft. Concurrent congenital anomalies included skin tag, hemifacial microsomia, and cleft palate. The mean duration of follow-up was $78.273{\pm}72.219$ months and the mean ratio of the lengths of both sides of the lip was $1.048{\pm}0.071$. Scar widening occurred as a postoperative complication in some patients. No cases of wound infection, bleeding, or wound dehiscence occurred. Conclusions For the successful correction of macrostomia, plastic surgeons should consider both functional and aesthetic problems of the lip. Adequate repair of the orbicularis oris muscle, skin closure with Z-plasty, and medial overcorrection of the neo-oral commissure led to good results in our patients.

Bony Stability and Soft Tissue Changes after Orthognathic Surgery on Patients with Cleft (구순구개열 환자의 악교정 수술 후의 골조직 안정도와 연조직 변화율)

  • Shin, Heakyeong;Hsieh, Yuh-Jia;Liao, Yu-Fang;Lo, Lun-Jou;Jo, Myoung-Soo
    • Archives of Craniofacial Surgery
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    • v.13 no.1
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    • pp.4-10
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    • 2012
  • Purpose: The objective of this retrospective study was to assess the skeletal stability after orthognathic surgery for patients with cleft lip and palate. The soft tissue changes in relation to the skeletal movement were also evaluated. Methods: Thirty one patients with cleft received orthognathic surgery by one surgeon at the Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan. Osseous and soft tissue landmarks were localized on lateral cephalograms taken at preoperative (T0), postoperative (T1), and after completion of orthodontic treatment (T2) stages. Surgical movement (T0.T1) and relapse (T1.T2) were measured and compared. Results: Mean anteroposterior horizontal advancement of maxilla at point A was 5.5 mm, and the mean horizontal relapse was 0.5 mm (9.1%). The degree of horizontal relapse was found to be correlated to the extent of maxillary advancement. Mean vertical lengthening of maxilla at point A was 3.2 mm, and the mean vertical relapse was 0.6 mm (18.8%). All cases had maxillary clockwise rotation with a mean of 4.4 degrees. The ratio for horizontal advancement of nasal tip/anterior nasal spine was 0.54/1, and the ratio of A' point/A point was 0.68/1 and 0.69/1 for the upper vermilion/upper incisor tip. Conclusion: Satisfactory skeletal stability with an acceptable relapse rate was obtained from this study. High soft tissue to skeletal tissue ratios were obtained. Two-jaw surgery, clockwise rotation, rigid fixation, and alar cinch suture appeared to be the contributing factors for favorable results.

Use of repeat anterior maxillary distraction to correct residual midface hypoplasia in cleft patients

  • Richardson, Sunil;Krishna, Shreya;Bansal, Avi
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.43 no.6
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    • pp.407-414
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    • 2017
  • Objectives: The study was designed to evaluate the efficacy of performing a second, repeat anterior maxillary distraction (AMD) to treat residual cleft maxillary hypoplasia. Materials and Methods: Five patients between the ages of 12 to 15 years with a history of AMD and with residual cleft maxillary hypoplasia were included in the study. Inclusion was irrespective of gender, type of cleft lip and palate, and the amount of advancement needed. Repeat AMD was executed in these patients 4 to 5 years after the primary AMD procedure to correct the cleft maxillary hypoplasia that had developed since the initial procedure. Orthopantomogram (OPG) and lateral cephalograms were taken for evaluation preoperatively, immediately after distraction, after consolidation, and one year postoperatively. The data obtained was tabulated and a Mann Whitney U-test was used for statistical comparisons. Results: At the time of presentation, a residual maxillary hypoplasia was observed with a well maintained distraction gap on the OPG which ruled out the occurrence of a relapse. Favorable movement of the segments without any resistance was seen in all patients. Mean maxillary advancement of 10.56 mm was achieved at repeat AMD. Statistically significant increases in midfacial length, SNA angle, and nasion perpendicular to point A distance was achieved (P=0.012, P=0.011, and P=0.012, respectively). Good profile was achieved for all patients. Minimal transient complications, for example anterior open bite and bleeding episodes, were managed. Conclusion: Addressing the problem of cleft maxillary hypoplasia at an early age (12-15 years) is beneficial for the child. Residual hypoplasia may develop in some patients, which may require additional corrective procedures. The results of our study show that AMD can be repeated when residual deformity develops with the previous procedure having no negative impact on the results of the repeat procedure.

Non-Surgical Correction of Collapsed Posterior Occlusion in a Unilateral Cleft Lip and Palate Patient with Multiple Missing Teeth: A Case Report

  • Utkarsh Mangal;Hyeonseok Jinn;Heon Jo;Sung-Hwan Choi
    • Journal of Korean Dental Science
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    • v.17 no.3
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    • pp.151-162
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    • 2024
  • This case report demonstrates correction of functional occlusion in a patient with unilateral cleft lip and palate, achieved through nonsurgical orthodontic treatment. An 18-year-old male with unilateral cleft lip and palate presented with posterior occlusion collapse, attributed to the lateral collapse of the right maxillary arch, severe lingual inclination of mandibular molars, and multiple missing teeth. With the usage of fixed orthodontic appliances and mini-implant anchors, functional posterior occlusion, proper anterior overjet, and improved soft tissue profile was achieved. This case exemplifies the impact of specialized orthodontic care in enhancing both function and aesthetics for patients with congenital oral conditions.