DESIGN: Retrospective observational study.
SETTING: Two regional cleft-referral centers.
MAIN OUTCOME MEASURES: In the current study, 101 pairs of dental models of non-syndromic CUCLP patients were retrieved from hospital archives. Each occlusal relationship from central incisor till the first permanent molars were scored except the lateral incisor. Sum of 10 occlusal relationships in each study sample gave a total occlusion score. The primary outcome was the mean total occlusion score.
RESULTS: According to MHB, a mean (standard deviation) total occlusion score of -8.92 (6.89) was determined. Based on treatment outcome, 66 cases were favorable (grades 1, 2, and 3) and 35 cases were unfavorable (grades 4 and 5). Chi-square tests indicated, difference of cheiloplasty ( P = .001) and palatoplasty ( P < .001) statistically significant. Five variables-gender, family history of cleft, cleft side, cheiloplasty, and palatoplasty-were analyzed with a logistic regression model.
CONCLUSIONS: Final model indicated that cases treated with modified Millard technique (cheiloplasty) and Veau-Wardill-Kilner method (palatoplasty) had higher odds of unfavorable treatment outcome.
DESIGN: Retrospective study.
SETTING: School of Dental Science, Universiti Sains Malaysia.
SUBJECTS: Eighty-four Bangladeshi children with nonsyndromic UCLP who received cheiloplasty and palatoplasty.
MAIN OUTCOME MEASURES: Dental models were taken at 5 to 12 years of age (man: 7.69), and dental arch relationships were assessed using modified Huddart/Bodenham index (mHB) by two raters. Kappa statistics was used to evaluate the intra- and interexaminer agreements, chi-square was used to assess the associations, and logistic regression analysis was used to explore the responsible factors that affect DAR.
RESULTS: The total mHB score (mean [SD]) was -8.261 (7.115). Intra- and interagreement was very good. Using crude and stepwise backward regression analysis, significant association was found between positive history of class III (P = .025, P = .030, respectively) and unfavorable DAR. Complete UCLP (P = .003) was also significantly correlated with unfavorable DAR.
CONCLUSION: This multivariate study suggested complete type of UCLP and positive history of class III had a significantly unfavorable effect on the DAR.
METHOD: A total of one hundred and seven patients from age five to twelve years old with non-syndromic unilateral cleft lip and palate were included in the study. These patients have received cheiloplasty and one stage palatoplasty surgery but yet to receive alveolar bone grafting procedure. Five assessors trained in the use of the EUROCRAN index underwent calibration exercise and ranked the dental arch relationships and palatal morphology of the patients' study models. For intra-rater agreement, the examiners scored the models twice, with two weeks interval in between sessions. Variable factors of the patients were collected and they included gender, site, type and, family history of unilateral cleft lip and palate; absence of lateral incisor on cleft side, cheiloplasty and palatoplasty technique used. Associations between various factors and dental arch relationships were assessed using logistic regression analysis.
RESULT: Dental arch relationship among unilateral cleft lip and palate in local population had relatively worse scoring than other parts of the world. Crude logistics regression analysis did not demonstrate any significant associations among the various socio-demographic factors, cheiloplasty and palatoplasty techniques used with the dental arch relationship outcome.
CONCLUSIONS: This study has limitations that might have affected the results, example: having multiple operators performing the surgeries and the inability to access the influence of underlying genetic predisposed cranio-facial variability. These may have substantial influence on the treatment outcome. The factors that can affect unilateral cleft lip and palate treatment outcome is multifactorial in nature and remained controversial in general.
MATERIALS AND METHODS: One hundred and one sets of dental models of patients having CUCLP were assessed in this retrospective study. Five examiners that were blinded to case-specific information scored the dental models at two instances with an interval of two weeks to ensure memory bias elimination (5 × 101 × 2 = 1010 observations). Calibration courses were conducted prior to scoring and each examiner was provided with scoring sheets, pictures of GOSLON reference models and flowcharts explaining the scoring method.
RESULTS: According to GOSLON index, a mean (SD) GOSLON score of 3.04 (1.25) was determined. Based on treatment outcome groups, 62 patients had favorable (grade 1, 2, and 3) and 39 cases had unfavorable (grade 4 and 5) treatment outcome. Chi-square tests revealed a significant association of gender (P = 0.002), cheiloplasty (P = 0.001) and palatoplasty (P
MATERIALS AND METHODS: It is a retrospective cross sectional study. Dental models were collected from archives of two cleft referral centers in Pakistan. Five blinded examiners scored 101 models twice at two week interval. The primary outcome was mean EUROCRAN scores based on dental arch relationships and palatal surface morphology.
RESULTS: A mean(SD) score of 2.72 (0.76) and 2.20 (0.73) was determined based on dental arch relationships and palatal surface morphology, respectively. According to the final logistic regression model, modified Millard technique (cheiloplasty) and Veau-Wardill-Kilners' method (palatoplasty) had higher odds of producing unfavorable treatment outcome.
CONCLUSIONS: Present study determined a fair and a fair to poor treatment outcome based on dental arch relationships and palatal surface morphology, respectively. Our study suggests a significant association between treatment outcome and primary surgical techniques for lip and palate. These findings could warrant a modification of management protocols to ensure improvement in future cleft outcomes.
OBJECTIVES: This study examined the speech and hearing status of Malay-speaking children with CLP residing in Kuala Lumpur.
METHODS: Parents whose children were between the age of 5 and 7 years were recruited via the Cleft Lip and Palate Association of Malaysia (CLAPAM) registry. Parents completed a survey and the children completed a speech and hearing assessment at the Audiology and Speech Sciences Clinic, Universiti Kebangsaan Malaysia.
OUTCOMES: Speech measures include nasality rating, nasalance scores, articulation errors and speech intelligibility rating, while hearing measures include hearing thresholds and tympanometry results for each child.
RESULTS: Out of 118 registered members who fulfilled the inclusion criteria, 21 agreed to participate in the study. The overall speech and hearing status of children in this sample were poor. Only four (19%) participants had normal speech intelligibility rating and normal hearing bilaterally. In terms of overall cleft management, only four (19%) participants were seen by a cleft team while seven (33%) had never had their hearing tested prior to this study.
CONCLUSION: Participants in this sample had poor outcomes in speech and hearing and received uncoordinated and fragmented cleft care. This finding calls for further large scale research and collaborative efforts into improving and providing centralised, multidisciplinary care for children born with CLP.
Methods: Eighteen male Dorper sheep were randomly distributed into three groups (n = 6 each group): group 1, RME with corticotomy on the buccal and palatal sides; group 2, conventional RME treatment; and group 3, no treatment. Post-RME, trabecular bone microstructure and new bone formation were evaluated by using microcomputed tomography (microCT) and histomorphometry after a 4- or 12-week retention period. Intergroup differences in bone quality and bone remodeling were analyzed by using two-way analysis of variance with Bonferroni post-hoc test.
Results: The bone volume fraction (bone volume [BV]/total volume [TV]) values relative to the control in groups 1 and 2 were 54.40% to 69.88% after the 4-week retention period and returned to approximately 80% after the 12-week retention period. The pooled BV/TV values of the banded teeth in groups 1 and 2 were significantly lower than those of the control after the 4-week retention period (p < 0.05). However, after the 12-week retention period, the pooled BV/TV values in group 2 were significantly lower than those in groups 1 and 3 (p < 0.05). Histomorphological analysis showed that the new bone formation area in group 1 was approximately two to three times of those in group 2 and control.
Conclusions: Corticotomy significantly enhanced the restoration of bone quality after the retention periods for banded teeth. This benefit might result from the increased new bone formation after corticotomy.
METHODS: A prospective 7-country clinical trial of 302 OSA patients, who met the selection criteria, and underwent nose, palate and/or tongue surgery. Pre- and post-operative data were recorded and analysed based on both the Sher criteria (apnoea hypopnea index, AHI reduction 50% and <20) and the SLEEP-GOAL.
RESULTS: There were 229 males and 73 females, mean age of 42.4±17.3 years, mean BMI 27.9±4.2. The mean VAS score improved from 7.7±1.4 to 2.5±1.7 (p<0.05), mean Epworth score (ESS) improved from 12.2±4.6 to 4.9±2.8 (p<0.05), mean body mass index (BMI) decreased from 27.9±4.2 to 26.1±3.7 (p>0.05), gross weight decreased from 81.9±14.3kg to 76.6±13.3kg. The mean AHI decreased 33.4±18.9 to 14.6±11.0 (p<0.05), mean lowest oxygen saturation (LSAT) improved 79.4±9.2% to 86.9±5.9% (p<0.05), and mean duration of oxygen <90% decreased from 32.6±8.9 minutes to 7.3±2.1 minutes (p<0.05). The overall success rate (302 patients) based on the Sher criteria was 66.2%. Crosstabulation of respective major/minor criteria fulfilment, based on fulfilment of two major and two minor or better, the success rate (based on SLEEP-GOAL) was 69.8%. Based solely on the Sher criteria, 63 patients who had significant blood pressure reduction, 29 patients who had BMI reduction and 66 patients who had clinically significant decrease in duration of oxygen <90% would have been misclassified as "failures".
CONCLUSION: AHI as a single parameter is unreliable. Assessing true success outcomes of OSA treatment, requires comprehensive and holistic parameters, reflecting true end-organ injury/function; the SLEEP-GOAL meets these requirements.