Michelle Kornbluth1, Richard E Campbell2, John Daskalogiannakis1,3, Elizabeth J Ross4, Patricia H Glick5, Kathleen A Russell6, Jean-Charles Doucet7, Ronald R Hathaway8, Ross E Long9, Thomas J Sitzman10. 1. 1 Department of Dentistry, The Hospital for Sick Children, Toronto, Ontario, Canada. 2. 2 Division of Pediatric Dentistry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States. 3. 3 Department of Orthodontics, University of Toronto, Toronto, Ontario, Canada. 4. 4 Department of Dentistry, Boston Children's Hospital, Boston, MA, USA. 5. 5 Barrow Cleft and Craniofacial Center, Phoenix, AZ, USA. 6. 6 Division of Orthodontics, Dalhousie University, Halifax, Nova Scotia, Canada. 7. 7 Division of Oral and Maxillofacial Science, Dalhousie University, Halifax, Nova Scotia, Canada. 8. 8 Division of Craniofacial Plastic and Reconstructive Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. 9. 9 Lancaster Cleft Palate Clinic, Lancaster, PA, USA. 10. 10 Division of Plastic Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA.
Abstract
OBJECTIVE: To compare dental arch relationship, craniofacial form, and nasolabial aesthetic outcomes among cleft centers using distinct methods of presurgical infant orthopedics (PSIO). DESIGN: Retrospective cohort study. SETTING: Four cleft centers in North America. PATIENTS: One hundred ninety-one children with repaired complete unilateral cleft lip and palate (CUCLP). MAIN OUTCOME MEASURES: Dental arch relationship was assessed using the GOSLON Yardstick. Craniofacial form was assessed by 12 cephalometric measurements. Nasolabial aesthetics were assessed using the Asher-McDade system. Assessments were performed between 6 and 12 years of age. RESULTS: The center that used no PSIO achieved the most favorable dental arch relationship and maxillomandibular relationship, with a median GOSLON score of 2.3 ( P < .01) and an ANB angle of 5.1° ( P < .05). The proportion of children assigned a GOSLON score of 4 or 5, predictive of the need for orthognathic surgery in adolescence, was 16% at the center that used no PSIO and no secondary surgery, compared to 76% at the centers that used the Latham appliance and early secondary lip and nose surgery ( P < .01). The center that used no PSIO and no secondary surgery achieved significantly less favorable nasolabial aesthetic outcomes than the centers using Latham appliance or nasoalveolar molding (NAM) ( P < .01). CONCLUSIONS: Effects of active PSIO are multifaceted and intertwined with use of revision surgery. In our study, centers using either the Latham appliance combined with early revision surgery or the NAM appliance without revision surgery achieved better nasolabial aesthetic outcomes but worse maxillary growth, compared to a center using no PSIO and secondary surgery.
OBJECTIVE: To compare dental arch relationship, craniofacial form, and nasolabial aesthetic outcomes among cleft centers using distinct methods of presurgical infant orthopedics (PSIO). DESIGN: Retrospective cohort study. SETTING: Four cleft centers in North America. PATIENTS: One hundred ninety-one children with repaired complete unilateral cleft lip and palate (CUCLP). MAIN OUTCOME MEASURES: Dental arch relationship was assessed using the GOSLON Yardstick. Craniofacial form was assessed by 12 cephalometric measurements. Nasolabial aesthetics were assessed using the Asher-McDade system. Assessments were performed between 6 and 12 years of age. RESULTS: The center that used no PSIO achieved the most favorable dental arch relationship and maxillomandibular relationship, with a median GOSLON score of 2.3 ( P < .01) and an ANB angle of 5.1° ( P < .05). The proportion of children assigned a GOSLON score of 4 or 5, predictive of the need for orthognathic surgery in adolescence, was 16% at the center that used no PSIO and no secondary surgery, compared to 76% at the centers that used the Latham appliance and early secondary lip and nose surgery ( P < .01). The center that used no PSIO and no secondary surgery achieved significantly less favorable nasolabial aesthetic outcomes than the centers using Latham appliance or nasoalveolar molding (NAM) ( P < .01). CONCLUSIONS: Effects of active PSIO are multifaceted and intertwined with use of revision surgery. In our study, centers using either the Latham appliance combined with early revision surgery or the NAM appliance without revision surgery achieved better nasolabial aesthetic outcomes but worse maxillary growth, compared to a center using no PSIO and secondary surgery.
Authors: Hillary L Broder; Roberto L Flores; Sean Clouston; Richard E Kirschner; Judah S Garfinkle; Lacey Sischo; Ceib Phillips Journal: Plast Reconstr Surg Date: 2016-03 Impact factor: 4.730
Authors: A M Mercado; K A Russell; J Daskalogiannakis; R R Hathaway; G Semb; T Ozawa; A Smith; A Y Lin; R E Long Journal: Cleft Palate Craniofac J Date: 2015-04-06
Authors: C Asher-McDade; V Brattström; E Dahl; J McWilliam; K Mølsted; D A Plint; B Prahl-Andersen; G Semb; W C Shaw; R P The Journal: Cleft Palate Craniofac J Date: 1992-09
Authors: M Mars; C Asher-McDade; V Brattström; E Dahl; J McWilliam; K Mølsted; D A Plint; B Prahl-Andersen; G Semb; W C Shaw Journal: Cleft Palate Craniofac J Date: 1992-09
Authors: Jenny F Yang; John Smetona; Joseph Lopez; Connor Peck; Navid Pourtaheri; Derek M Steinbacher Journal: Plast Reconstr Surg Glob Open Date: 2021-12-06