| 1 |
Carrara CF, Ambrosio EC, Mello BZ et al.20
|
Three-dimensional evaluation of surgical techniques in neonates with orofacial cleft. |
2016 |
Brazil |
Analysis of 114 plaster casts of 57 children aged between 3 and 36 months, divided in two groups according to surgical techniques employed. |
To assess the dimensional alterations of the dental arches of neonates with unilateral complete CLP, before and after one- or two-stage palatoplasty. |
Subjects submitted to lip repair at three months and one-stage palatoplasty (at 12 months) presented better anteroposterior maxillary development, in comparison to those who underwent associated lip repair, ala nasi repair and anterior palatoplasty (at 3 months) and posterior palatoplasty at 12 months. Thus, the authors suggest that dental arch growth and development of neonates with cleft lip and palate may be influenced by the surgical technique employed, with better results, in this study, of one-stage palatoplasty. |
| 2 |
Dissaux C, Grollemund B, Bodin F, et al.12
|
Evaluation of 5-year-old children with complete cleft lip and palate: Multicenter study. Part 2: Functional results. |
2016 |
France |
80 participants averaging 5 years of age at the time of assessment, 20 of them from each center (10 with unilateral CLP, 10 with bilateral CLP) |
To assess functional results, maxillary growth and speech development in 4 French reference centers. |
The surgical technique performed (two-stage palate repair described by Talmant with Sommerland intravelar veloplasty) may present less negative impact on maxillary growth and good results on speech development. Periosteal graft in cleft palate repair was associated with the smaller number of fistulae in UCLP, but it seems to have negative impact on anteroposterior maxillary growth. Likewise, one-stage palatoplasty with Veau-Wardill flap had negative impact on sagittal and transverse maxillary growth. It should be noted that, in each center, surgeries were performed by the same surgeon. The authors suggest that further studies need to be carried out. |
| 3 |
Navas-Aparício, MC.19
|
Maxillary growth analysis after surgery in non-syndromic cleft palate |
2016 |
Costa Rica |
5 participants with CP, assessed at 5 years of age. |
The aim of this study is to determine whether there is impairment in deficient maxillary growth, in the anteroposterior and transverse direction, in children with isolated nonsyndromic CP. |
In this study, palatoplasty was performed at 17 months, in average (without specifying the technique). At 5 years of age, subjects presented an adequate maxillo-mandibular relation, with no growth deficiency in the anteroposterior direction. However, an asymmetry in transverse growth of the maxillary arch was noted, which may have been influenced by the secondary scarring process of the palate due to exposure of the bone during surgery. The author suggests that a study be carried out through different ages of the child, as the anteroposterior relation may occur belatedly. |
| 4 |
Gundlach KK, Bardach J, Filippow D, et al.13
|
Two-stage palatoplasty, is it still a valuable treatment protocol for patients with a cleft of lip, alveolus, and palate? |
2013 |
Germany and USA |
Plaster casts of 85 patients with complete CLP, assessed at the ages of 8 and 16 years, in three centers. |
Test the importance of two-stage palatoplasty on palatal growth speech development. |
Palatoplasty took place at about 12 months of age and it interferes on growth. Two-stage palatoplasty would be the high-value protocol for subjects with complete UCLP, which presents lower rates of posterior osteotomies performed. According to the authors, this would be a good technique regarding speech. |
| 5 |
Priya VK, Reddy JS, Ramakrishna Y, Reddy CP.17
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Post-surgical dentofacial deformities and dental treatment needs in cleft-lip-palate children: a clinical study. |
2011 |
India |
50 subjects aged 3 to 14 years submitted to lip and palate repair. |
To register post-surgical dentofacial deformities in children with CLP, and to evaluate dental alterations and other related problems in order to develop an appropriate treatment plan for oral therapy and rehabilitation of these children. |
The effect of cleft repair timing on global development of dentofacial skeletal structures showed insignificant differences between the various children with CLP submitted to surgery. Speech alterations (not specified) were present in 92% of the subjects who underwent palatoplasty (with various techniques). Many dentofacial anomalies were present in the individuals due to many factors, such as the type of surgery performed and growth pattern under the influence of functional unbalance of associated structures. The authors suggest that further longitudinal studies, with greater number of subjects, must be developed. |
| 6 |
Pradel W, Senf D, Mai R, Ludicke G, Eckelt U, Lauer G.11
|
One-stage palate repair improves speech outcome and early maxillary growth in patients with cleft lip and palate |
2009 |
Germany |
24 children with nonsyndromic unilateral and bilateral CLP or complete cleft palate |
To compare the result of speech and maxillary growth in children with CLP deformity after palate repair with one- or two-stage procedure, and to identify the best treatment protocol. |
Analyses showed a clear relation between the treatment protocol (timing of surgery and palate repair technique), speech outcome and early maxillary growth. One-stage repair, at the age between 9 and 12 months, showed a positive influence on speech development and initial maxillary growth, in contrast with the two-stage procedure. |
| 7 |
Vlastos IM, Koudoumnakis E, Houlakis M, Nasika M, Griva M, Stylogianni E9
|
Cleft lip and palate treatment of 530 children over a decade in a single centre. |
2009 |
Greece |
530 registries of children with CLP, CP or cleft lip |
To assess the care procedures and the outcomes of lip and palate repair. |
Palatoplasty with two-stage technique was performed between the ages of 10 and 14 months. Small extension CP cases were treated with simple approach of the palate tissue. The articulation disorders were present in more than 50% of the children submitted to palatoplasty; likewise, speech intelligibility was considered good or excellent in up to 83% of the cases. In both cases, regardless of the employed surgical technique, thirty-two percent of the subjects in the research needed orthodontic treatment. Children with CLP presented functional limitations and a variety of conditions that need to be followed up by a multiprofessional team. According to the authors, the otorhinolaryngologist may have an important role in the multidisciplinary team, treating otologic problems and interpreting a series of outcomes (related to phonology, the maxillary arch, and secondary procedures), The multidisciplinary protocol used in the center is effective, with good applicability and low levels of complications. |
| 8 |
Ito S, Noguchi M, Suda Y et al.10
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Speech evaluation and dental arch shape following pushback palatoplasty in cleft palate patients: Supraperiosteal flap technique versus mucoperiosteal flap technique. |
2006 |
Japan |
109 participants with CP (52) and UCLP (57); 62 of them were submitted to pushback palatoplasty with supraperiosteal flap technique, and 47 with mucoperiosteal flap technique |
To assess and compare the shape of the maxillary dental arch and speech in subjects with CP who underwent pushback palatoplasty, using the supraperiosteal flap technique or the mucoperiosteal flap technique. |
The findings suggest that pushback palatoplasty (performed, in average, at 16 months) that uses the supraperiosteal technique is more advantageous for the development of speech, when compared to the mucoperiosteal technique (performed at 16 months, in average). The shape of the dental arch is related to alterations in speech. Subjects with V-shaped dental arch had more alterations when compared to those with U-shaped arch. |
| 9 |
Oyama T, Sunakawa H, Arakaki K, et al.21
|
Articulation disorders associated with maxillary growth after attainment of normal articulation after primary palatoplasty for cleft palate. |
2002 |
Japan |
22 patients (evaluated, in average, at 9.6 years) with UCLP, who were submitted to one-stage palatoplasty with supraperiosteal flap technique. |
The study finds the paucity of information regarding the effect of the alterations on the dimensions of the dental arch, in consequence of maxillary growth and the appearance of articulation disorders between patients who had previously achieved normal articulation. |
With the change in growth of the dimensions of the dental arch, there was an increase in the occurrence of palatalization between patients who had already achieved normal articulation after primary palatoplasty (performed, in average, at 21 months). It’s important to emphasize that in the present study, palatalization occurred in patients with mixed dentition, who had smaller anterior palatal volume, linguoversion teeth and worse growth capability. The findings suggest the importance of early assessment of the dimensions of the dental arch and periodic assessment of speech articulation, even for patients who achieved normal articulation after primary palatoplasty. |
| 10 |
Pigott RW, Albery EH, Hathorn IS, et al.18
|
A comparison of three methods of hard palate repair. |
2002 |
UK |
185 cases of unilateral and bilateral complete cleft; the speech of 66 participants with UCLP was assessed. |
To compare the outcome in growth, speech and nasal symmetry of three methods of hard palate repair. |
Reduction in periosteal damage and time of exposure of the palatal area, from the Cuthbert Veau, to Von Langenbeck, to medial Langenbeck techniques, improved the incisor relations and the articulation. Seemingly, the improvement in maxillary arch development and the regularity of the hard palate contour diminished the difficulty of the child to position their tongue. According to the authors, this was an unexpected benefit of the medial Langenbeck technique, resulting in significant reduction of articulation alterations. No significant differences were reported between the three techniques concerning nasal air emission, nasal resonance or posterior performance of pharyngoplasty. |
| 11 |
Webb AA, Watts R, Read-Ward E et al.14
|
Audit of a multidisciplinary approach to the care of children with unilateral and bilateral cleft lip and palate |
2001 |
UK |
15 patients, 8 of whom with UCLP and 7 with bilateral CLP. |
To examine the children before concluding facial growth and during mixed dentition stage. To evaluate speech, facial appearance, the relations of the dental arches and the lateral cephalometric radiographs. |
In this study, lip repair and soft palate repair were performed simultaneously, between 4 and months of age; palatoplasty with Delaire technique occurred between 12 and 14 months. In the care of children with UCLP and bilateral CLP, the option for a multidisciplinary protocol and the use of primary surgical techniques (in this case, all performed by the same surgeon), which restored functionality of all structures involved, led to an outcome that requires minimum future intervention and allows these children to achieve almost normal results in terms of appearance, speech, and dental and craniofacial relations. Even though the sample was small in number, It must be recognized that the result, which included both UCLP and bilateral CLP, provided a broader general perspective of the cares related to cleft lip and palate, than that which would be furnished by assessing UCLP alone. |
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