• Title, Summary, Keyword: Bilateral cleft palate

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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.

Bilateral cleft lip (양측성 구순열)

  • Kim, Jong-Ryoul
    • Korean Journal of Cleft Lip And Palate
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    • v.10 no.1
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    • pp.39-56
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    • 2007
  • The bilateral cleft lip, a more severe form of clefting than unilateral cleft lip, involves separation of the lip along philtral lines, isolating the central segment (prolabium). Bilateral cleft lip may be either symmetrical or asymmetrical, in which case the cleft lip is split more on one side than on the other. The cleft affects the obvious facial form as an anatomic deformity and has functional consequences, affecting the child's ability to eat, speak, hear, and breathe. Although there would seem to be quite a variance in reported figures, ratios of cleft lip with or without cleft palate have gone as high as 1:500 and as low as 1:1000. It is known that less than 10% of cleft lips are bilateral. Although bilateral cleft lip is less common than unilateral cleft lip, the deformity is more severe, and the reconstructive technique is more complex. Surgery is the only treatment necessary for patients with bilateral cleft lip. Accompanying the evolution of surgical repair is the increasingly important role of orthodontic support with early presurgical alveolar and nasal molding. Repositioning the maxillary and alveolar segments into a more anatomic position allows the surgeon to repair the lip and associated nasal deformity under more optimal conditions. The purpose of this article is to review the related anatomy, presurgical management, and surgical management of bilateral cleft lip.

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Reconstruction of alveolar bone defect in bilateral cleft lip and palate using bifocal distraction-compression osteosynthesis (양측성 구순구개열 환자의 치조골 결손부의 재건치료를 위한 distraction-compression osteosynthesis)

  • Lee Jin-Kyung;Baek Seung-Hak;Lee Jong-Ho
    • Korean Journal of Cleft Lip And Palate
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    • v.7 no.1
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    • pp.47-61
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    • 2004
  • The closure of a wide alveolar cleft and fistula in cleft patients and the reconstruction of a maxillary dentoalveolar defect in bilateral cleft lip and palate (BCLP) patients are challenging for both orthodontists and oromaxillofacial surgeons. It is due to the difficulty in achieving complete closure by using local attached gingiva (palatal flap) and the great volume of bone required for the graft. In this article, the authors used bifocal distraction-compression osteosynthesis(BDCO) to create a segment of new alveolar bone and attached gingiva for the complete approximation of a wide alveolar cleft/fistula and the reconstruction of a maxillary dentoalveolar defect. Since the alveoli and gingivae on both ends of the cleft were approximated after BDCO, the need for extensive alveolar bone grafting was eliminated. It also could create new alveolar bone and gingiva for orthodontic tooth movement and implant.

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Early outcomes of cleft and palatal width following anterior palate repair (vomerine flap) in infants with wide cleft lip and palate

  • Saad, Arman Zaharil Mat;Chai, Koh Siang;Sulaiman, Wan Azman Wan;Johar, Siti Fatimah Noor Mat;Halim, Ahmad Sukari
    • Archives of Plastic Surgery
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    • v.46 no.6
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    • pp.518-524
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    • 2019
  • Background Anterior palatal repair performed during cleft lip repair using a vomerine flap may assist in recruiting additional soft tissue for subsequent completion of palatoplasty, especially in patients with a wide cleft. We present our early results in the hope of triggering a re-evaluation of this technique regarding its advantages for maxillary growth through further studies of patients with a wide cleft. Methods A retrospective analysis of patients with complete unilateral and bilateral cleft lip and palate was performed, including cleft and palatal measurements taken during initial surgery (lip repair together with anterior palate repair) and upon completion of palatoplasty. Results In total, 14 patients were included in this study, of whom nine (63.3%) had unilateral cleft lip and palate and five (37.5%) had bilateral cleft. All patients had a wide cleft palate. Lip and anterior palate repair was done at a median age of 3 months, while completion of palatoplasty was done at a median age of 10.5 months. Measurements taken upon completion of palatoplasty showed significant cleft width reduction in the mid-palate and intertubercle regions; however, the palatal arch distances at nearby landmarks showed non-significant marginal changes. Conclusions Anterior palate repair using a vomerine flap significantly reduced the remaining cleft width, while the palatal width remained. Further research is warranted to explore the long-term effects of this technique in wide cleft patients in terms of facial growth.

Correction of Bilateral Cleft Lip Using Modified Noordhoff Technique (개선된 Noordhoff 방법을 이용한 양측성 구순열의 교정)

  • Cho, Byung Chae;Lee, Yong Jig
    • Archives of Plastic Surgery
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    • v.33 no.4
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    • pp.399-406
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    • 2006
  • Purpose: The authors accessed the anthropometric measurements of fourty non-cleft normal a three-month-old infant and using this obtained data as a basic guideline, authors applied the modified Noordhoff technique for the treatment of bilateral cleft lip. Methods: Over a period of 10 years, a total of 21 bilateral cleft lips were operated. 13 cases of complete and 8 cases of incomplete bilateral cleft lip and palate. In the complete type of bilateral cleft palate, elastic head cap and passive intraoral appliance were applied at 1 to 2 week of age for 2 months duration. The definitive cheiloplasty was performed at 3 months of age using the modified Noordhoff technique. Results: After a follow-up period ranging one to nine years, most patients presented with cosmetically and functionally satisfying results, with an exception of two cases where an undesired peaking effect of the vermilion and dimpling of the vermilion mucosa was encountered. Conclusion: Accessing the anthropometric measurements of fourty non-cleft normal three-month-old infant and using this obtained dara as a guideline, the modified Noordhoff technique can be applied to either complete or incomplete bilaterally cleft lip providing more naturally pleasing and cosmetically satisfying scars that lie in harmony with the philtral ridges, lip tubercle positioned just below the vermilion and a distinct white line and Cupid's bow.

Treatment of the infant with bilateral cleft lip and palate (양측성 구순구개열 신생아의 치료)

  • Kim Su Jung;Kang Seung Goo;Lee Young Jun;Park Young Guk
    • Korean Journal of Cleft Lip And Palate
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    • v.6 no.2
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    • pp.107-115
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    • 2003
  • The case unveils an early orthodontic intervention on 3-week old infant innately with bilateral cleft lip and palate. Presurgical Nasoalveolar Molding(PNAM) procedures were carried out for 2 months for the sake to diminish the anticipated strain of postsurgical scar by means of the retraction of protruded premaxilla and the extension of collapsed columella. The gap on the alveolar cleft decreased by 2,5 mm, and the columella manifested 1. 5 mm increase of its length, which yielded the consequent downward and backward movement of premaxilla, and expected to bring down the technical complexity of primary lip surgery. PNAM with sophisticated technical procedures at an optimal timing disclosed the passive molding of the alveolar segments and the formation of nasolabial soft tissue integuments and permitted one-time primary lip surgery.

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CLINICAL STUDY OF SURGICAL TREATMENTS ON CLEFT LIP AND CLEFT PALATE (순열 및 구개열 환자의 외과적 치료방법에 관한 임상적 연구)

  • Shin, Byung-Chol;Lee, Dong-Keun;Sung, Gil-Hyun
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.18 no.4
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    • pp.529-545
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    • 1996
  • In order to find the distribution, causes and treatments of cleft lip and/or palate, I analyzed 113 patients of cleft lip and/or palate who were treated in the Department of Oral and Maxillofacial Surgery, School of Dentistry, Wonkwang University, Iksan, Chunbuk, KOREA from September 1984 to August 1995. The obtained results were as follows. 1. In total 113 patients of cleft lip and/or palate, male patients were 63 cases (56%) and female patients were 50 cases (44%). 2. In distribution of cleft lip and/or palate, cleft lip patients were 30 cases (27%), cleft palate patient were 23 cases (20%) and cleft lip and palate patients were 60 cases (53%). 3. Unilateral cleft lip patients (78 cases: 87%) were larger than bilateral cleft lip. In unilateral cleft lip patients, lip side cleft lip patients (45 cases: 50%) were larger than right side cleft lip patients (33 cases: 37%). 4. Possible causes of cleft lip and/or palate were related with familial tendency, drug intoxication, malnutrition, old maternal age, stress and hypoxia during 4-8 weeks of pregnancy period. 5. The favorite treated method of cleft lip was Millard rotation-advancement method. Probably the most popular operated period was 3 months. 6. The useful operating technique of cleft palate was Wardill V-Y flap method. The most popular period has been 18 to 24 months. 7. In 11 patients with velopharyngeal insufficiency, hypernasality decreased by superior based pharyngeal flap pharyngoplasty. 8. Cleft alveolus was treated with autogenous and allogeneic bone graft. The most appropriate operation period was 9 to 11 years.

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RECENT TRENDS IN INCIDENCE AND MANAGEMENT OF CLEFT LIP AND PALATE (구순열과 구개열의 발생요인 및 치료 경향)

  • Yoon, Chun-Ju;Ryu, Sun-Youl
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.28 no.4
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    • pp.295-309
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    • 2006
  • The present study was aimed to evaluate the incidence, etiological factors, and management of cleft lip and palate. Two hundred and twenty patients with cleft lip and/or cleft palate who were treated at Department of Oral and Maxillofacial Surgery, Chonnam National University Hospital, during the period between January 1994 and December 2003 were reviewed. The ratios of cleft lip : cleft lip with cleft palate : and cleft palate were 0.4:1.1:1. Males were more common than females in cleft lip (1.3:1) and cleft lip and palate (2.5:1), while females were more common than males in cleft palate (1:1.3). In the cleft side, left clefts were more prevalent than right clefts (cleft lip 1.3:1, cleft lip and palate 1.6:1). Unilateral clefts were more common than bilateral clefts in cleft lip (79:21). Cleft lip and cleft palate were more common in those with blood type A (34.5%) than those with other types. There was no significant relationship between birth season and frequency of clefts. The clefts were common in the first-born (48.8%), and in mothers aged between 25 and 29 (51.7%). Medication (24.7%) and stress (16.7%) during the first trimester were noted. Positive familial history was noted in 13 cases (5.9%). Thirty-two cases (15%) were associated with other congenital anomalies, in which tonguetie (40.6%) and congenital heart disease (21.9%) were most common. Among 100 patients with cleft palate, 77 patients had middle ear disease (77%), which occurred predominently in the incomplete cleft palate. Seventy-six among the 77 patients received myringotomy and ventilation tube insertion, and the remaining one received antibiotic medication only. Cleft lips were treated primarily at 3 to 6 months, and cleft palates were at 1 to 2 years. Treatment regimens included modified Millard method mainly in the cleft lip, and Wardill V-Y, Dorrance method, and Furlow method in the cleft palate. The percentage of palatal lengthening as type of cleft palate was greater in the incomplete cleft palate group (11.2%) than in the complete cleft palate group (9.6%). The percentage of palatal lengthening as operating method was no difference between the Furlow method (10.9%) and the push back method (10.7%). As postoperative complications, hypertrophic scar was most frequent in the cleft lip, and oronasal fistula in the cleft palate. In summary, it was shown that medication and stress during the first trimester of pregnancy were frequently associated with cleft lip and cleft palate, adequate timing and selection of method of operation are important factors to obtain morphologically and functionally good results. Furthermore prevention and treatment of middle ear disease are important in cleft palate patients because of its high co-occurrence.