Bruno Grollemund

Relational development in children with cleft lip and palate: influence of the waiting period prior to the first surgical intervention and parental psychological perceptions of the abnormality

BackgroundThe birth of a child with a cleft lip, whether or not in association with a cleft palate, is a traumatic event for parents. This prospective, multidisciplinary and multi-centre study aims to explore the perceptions and feelings of parents in the year following the birth of their child, and to analyse parent–child relationships. Four inclusion centres have been selected, differing as to the date of the first surgical intervention, between birth and six months. The aim is to compare results, also distinguishing the subgroups of parents who were given the diagnosis in utero and those who were not.Methods/DesignThe main hypothesis is that the longer the time-lapse before the first surgicalintervention, the more likely are the psychological perceptions of the parents to affect the harmonious development of their child. Parents and children are seen twice, when the child is 4 months (T0) and when the child is one year old (T1). At these two times, the psychological state of the child and his/her relational abilities are assessed by a specially trained professional, and self-administered questionnaires measuring factors liable to affect child–parent relationships are issued to the parents. The Alarme Détresse BéBé score for the child and the Parenting Stress Index score for the parents, measured when the child reaches one year, will be used as the main criteria to compare children with early surgery to children with late surgery, and those where the diagnosis was obtained prior to birth with those receiving it at birth.DiscussionThe mental and psychological dimensions relating to the abnormality and its correction will be analysed for the parents (the importance of prenatal diagnosis, relational development with the child, self-image, quality of life) and also, for the first time, for the child (distress, withdrawal). In an ethical perspective, the different time lapses until surgery in the different protocols and their effects will be analysed, so as to serve as a reference for improving the quality of information during the waiting period, and the quality of support provided for parents and children by the healthcare team before the first surgical intervention.Trial RegistrationClinicalTrials.gov Identifier: NCT00993993.

Evaluation of 5-year-old children with complete cleft lip and palate: Multicenter study. Part 2: Functional results

BACKGROUND AND PURPOSE Cleft surgery is marked by all the controversies and the multiplication of protocols, as it has been shown by the Eurocleft study. The objective of this pilot study is to start a comparison and analyzing procedure between primary surgical protocols in French centers. METHODS Four French centers with different primary surgical protocols for cleft lip and palate repair, have accepted to be involved in this retrospective study. In each center, 20 consecutive patients with complete cleft lip and palate (10 UCLP, 10 BCLP per center), non syndromic, have been evaluated at a mean age of 5 [range, 4-6]. In this second part, maxillary growth and palatine morphology were assessed on clinical examination and on dental casts (Goslon score). Speech was also evaluated clinically (Borel-maisonny classification) and by Aerophonoscope. RESULTS Veau-Wardill-Killner palatoplasty involves a higher rate of transversal maxillary deficiency and retromaxillary. The fistula rate is statistically lower with tibial periosteum graft hard palate closure but this technique seems to give retromaxillary. Malek and Talmant two-stage-palatoplasty techniques reach Goslon scores of 1 or 2. Considering speech, Sommerlad intravelar veloplasty got higher outcomes. CONCLUSIONS Primary results. Extension to other centers required. The two-stage palatoplasty, including a Sommerlad intravelar veloplasty seems to have the less negative impact on maxillary growth, and to give good speech outcomes. LEVEL OF EVIDENCE Therapeutic study. Level III/retrospective multicenter comparative study.

Evaluation of success of alveolar cleft bone graft performed at 5 years versus 10 years of age

BACKGROUND AND PURPOSE Although alveolar cleft bone grafting is the most widely accepted approach, controversies remain on the operative timing. METHODS A consecutive retrospective series of 28 patients who received alveolar bone grafting was examined and divided into 2 groups depending on the age at the time of bone graft. Group A (14 patients) was operated at a mean age of 5.2 years [range, 4-7] and Group B (14 patients) at a mean age of 10 years [range, 8.5-13]. All the children were assessed clinically and by Cone Beam Computed Tomography (CBCT) before bone grafting and 6 months post-operatively. Cleft and bone graft dimensions, volumes were assessed using Osirix v.3.9.2. Residual bone graft coefficient (Bone Graft Volume on 6-months Postoperative CBCT/Alveolar Cleft Volume) was calculated. Complications, tooth movement or dental agenesis were also reported. RESULTS The sample was uniform within both groups, considering cleft forms, pre-surgical fistula rate and cleft volume. Residual bone graft coefficient reached 63.3% in Group A and 46.2% in Group B (p = 0.012). Results of residual bone graft are also influenced by tooth eruption through the graft (p = 0.007 in Group A and p = 0.02 in Group B). CONCLUSIONS This 3D analysis highlighted higher success of alveolar bone grafts when children are operated earlier around 5 years. LEVEL OF EVIDENCE Therapeutic study. Level III/retrospective comparative study.

Left-sided predominance of hypodontia irrespective of cleft sidedness in a French population.

Objective Individuals with oral clefts exhibit considerably more dental anomalies than do individuals without clefts. Our aim was to evaluate the prevalence of tooth agenesis in a sample composed of 124 children (81 boys and 43 girls, mean age 12.5 years) with clefts registered with the Cleft Palate Center in Strasbourg (France). Design Cleft types and dental agenesis were assessed by clinical and radiographic examination. Cleft types were divided into four groups according to the clinical extent of the cleft (cleft lip only [CL, 12.9%], cleft lip and alveolus [CLA, 4%], cleft lip and palate [CLP, 49.2%], and cleft palate only [CP, 33.9%]). Results Of the subjects 63% had evidence of hypodontia: maxillary lateral incisors (54%) and upper and lower premolars (32%) were the most common missing teeth. The number of dental ageneses associated with CP (54%) and CLP (79%) was significantly higher than that with CL (33%). All these anomalies were found in proportionately higher frequencies as the severity of the cleft increased, and we found left side predominance for hypodontia (p < .01) irrespective of cleft sidedness. Conclusions Both right-sided and left-sided clefts were more frequently correlated with left-sided dental agenesis. This left-sided prevalence suggests that common signaling malfunctions might be involved, both in dental development anomalies and cleft genesis.

Towards a new procreation ethic: the exemplary instance of cleft lip and palate

The improvement of ultrasound scan techniques is enabling ever earlier prenatal diagnosis of developmental anomalies. In France, apart from cases where the mother’s life is endangered, the detection of “particularly serious” conditions, and conditions that are “incurable at the time of diagnosis” are the only instances in which a therapeutic abortion can be performed, this applying up to the 9th month of pregnancy. Thus numerous conditions, despite the fact that they cause distress or pain or are socially disabling, do not qualify for therapeutic abortion, despite sometimes pressing demands from parents aware of the difficulties in store for their child and themselves, in a society that is not very favourable towards the integration and self-fulfilment of people with a disability. Cleft lip and palate (CLP), although it can be completely treated, is one of the conditions that considerably complicates the lives of child and parents. Nevertheless, the recent scope for making very early diagnosis of CLP, before the deadline for legal voluntary abortion, has not led to any wave of abortions. CLP in France has the benefit of a exceptional care plan, targeting both the health and the integration of the individuals affected. This article sets out, via the emblematic instance of CLP, to show how present fears of an emerging “domestic” or liberal eugenic trend could become redundant if disability is addressed politically and medically, so that individuals with a disability have the same social rights as any other citizen.

Treatment of Class III malocclusion: the key role of the occlusal plane

Patients with a Class III malocclusion generally present with a counterclockwise inclination of the occlusal plane, converging with Campers line towards the front. This slope has an effect on mandibular movement (forward posture) and on chewing mechanisms in general. As dysfunctional mastication is likely to influence facial growth and inter-arch stability negatively, early orthopedic therapy of the occlusal unbalance concurrent with Class III malocclusion is justified. The aim of this article is to present a method of Class III treatment based on a correct re-orientation of the occlusal plane in order to achieve an optimal masticatory mechanism, essential for stability of early treatment outcomes.

Effets de la disjonction maxillaire rapide sur la rétention des canines chez les patients présentant un déficit squelettique transversal maxillaire

INTRODUCTION This study focuses on the effects of rapid maxillary disjunction on the tendency to canine impaction in patients displaying a maxillary transverse skeletal deficiency. MATERIALS AND METHODS Using the segmentation method described by Ericson and Kurol and modified by Lindauer, et al., a series of panoramic views taken before and after disjunction was studied to compare changes in the position of the tip of the maxillary canine depending on whether it was covered or not by the homolateral lateral incisor, according to the side and patients sex. The cohort consisted of 193 patients, all treated using a palatal expander welded to bands. RESULTS A statistically significant improvement was observed in all categories regarding the position of the maxillary canine. Disjunction was successful in 87% of cases in our sample. No significant differences were found according to side or sex.

Séniors et orthodontie : du déni au choix raisonné

When patients older than 60 decide to undergo orthodontic treatment, their motivation is not merely for esthetic purposes; it is also intended to preserve their biological capital. Their treatment is often complicated. The orthodontist has to take into account any particularities related to their past dental or even orthodontic history. Their treatment are freed, sometimes due to necessary compromises, from constraints that are determined by the occlusion, the periodontium or by prosthetic devices which are sometimes implant borne. For some patients, the original shape of their teeth that make up their smile are an integral part of their personality. By preserving the integrity of these teeth with an orthodontic treatment they avoid the sudden and jarring transformation of their smile and maintain their identity. Therapeutic choices that combine orthodontics and prosthetics and sometimes surgery can preserve the senescence of a face.

SFCP CO-21 - Correction de la fente alvéolaire par greffe osseuse à 5 ans ou à 10ans : évaluation clinique et radiologique.

28 enfants porteurs de fentes labio-palatines, repartis en 2 groupes en fonction de l’âge (groupe precoce 5,5 ans et tardif 10 ans) ont beneficie d’une greffe osseuse alveolaire. L’imagerie Cone- Beam CT est realisee en pre-operatoire et a 6 mois. Le greffon est evalue par le logiciel Osirix v.3.9.2. Resultats Les types de fentes (24 fentes totales et 4 labio-alveolaires) sont repartis de facon homogene dans chaque groupe. Les volumes moyens pre-operatoires de la fente sont de 475mm3(groupe precoce) et 495mm3 (groupe tardif). Le pont osseux est obtenu dans 100% des cas pour le groupe precoce. La hauteur maximale du greffon represente 74% en moyenne de la hauteur de la fente alveolaire dans le groupe precoce et 60% dans le groupe tardif. La profondeur maximale est evaluee a 91% de celle de la fente alveolaire dans le groupe precoce contre 60% en tardif. Le volume moyen du greffon restant represente 66% du volume initial pour le groupe precoce et de 46% pour le groupe tardif. L’exposition du greffon est notee une fois dans le groupe tardif. Conclusion La greffe osseuse alveolaire precoce a 5 ans, facilement realisable, semble apporter de meilleurs resultats. L’evaluation par CBCT peu irradiante pour l’enfant comporte des limites mais permet neanmoins une evaluation plus precise.