Leena P. Ylikontiola

Guided bone regeneration using a titanium-reinforced ePTFE membrane and particulate autogenous bone: the effect of smoking and membrane exposure

OBJECTIVES The objectives of this study were to describe and evaluate treatment outcomes achieved using guided bone regeneration (GBR) with autogenous bone grafting, particularly the effect of smoking and membrane exposure. STUDY DESIGN Twenty-seven bone augmentations were carried out using intraorally harvested particulate bone grafts covered by titanium-reinforced ePTFE membranes. Healing events were monitored and treatment outcomes were evaluated. RESULTS Twenty-three (85%) augmentations were successful and 4 (15%) were unsuccessful. Augmentations performed in nonsmokers were successful in 95% of cases, whereas the success rate in smokers was 63%. There were 4 (15%) cases of membrane exposure, but none affected the final outcome. Signs of soft tissue inflammation were present in 10 (37%) of the augmentation sites, more often in smokers (75%) than in nonsmokers (21%). This difference was statistically significant (P = .008). CONCLUSIONS The results of this study support the use of this technique in the augmentation of resorbed alveolar processes. Smoking was associated with poor treatment outcomes in this study. Membrane exposures did not seem to affect outcomes.

Experience with craniosynostosis treatment using posterior cranial vault distraction osteogenesis

Background: Craniosynostosis compromises the cranial vault volume, severely impede growth, and may lead to increased intracranial pressure (ICP). Posterior cranial vault (PCV) distraction osteogenesis (DO) offers an excellent treatment opportunity for this condition. This article intends to describe the outcomes of PCV DO. Materials and Methods: Nine males and seven female children indicated for PCV DO were included in the study. The single vector distraction devices with quick-disconnect distraction rods, a type of miniaturized hardware, was used in all cases. Result: Seven of the 16 patients had a history of one or more prior cranioplasty. All reoperations in this series were performed for the indication of raised ICP including five of the scaphocephaly patients and the syndromic patients. Clinical signs of raised ICP were present in all patients with either measured raised intracranial pressure or those with clinical signs of raised ICP preoperatively. There was substantial decrease in the ICP postoperatively. Discussion: The outcomes of this study were encouraging. Placing the distractor stems as flat as possible against the outer layer of the cranial bone seems to be a very important maneuver. This keeps the distractor stem less proud and less likely to sustain future trauma. Removal of the distractor stems keeps the devices further away from the risk of later traumatic dislodgement. Moreover, miniaturized distractors allow precise control of the rate and the amount of distraction.

Incidence of palatal fistula formation after primary palatoplasty in northern Finland

OBJECTIVE The purpose of this retrospective study was to determine the incidence of palatal fistulas after primary cleft palate repair. STUDY DESIGN The study included 136 patients who were treated at the Oulu University Hospital cleft lip and palate center between 1998 and 2011. All patients were treated by the same surgeons with 1-stage palatoplasty closing the hard and soft palate concurrently. RESULTS The overall frequency of postoperative fistula was 9.6% of patients. Patients with cleft lip and palate (20.0%) were more likely to develop postoperative palatal fistulas than patients with cleft palate (6.6%). Surgical technique and cleft severity were not significant factors for the development of palatal fistulas. CONCLUSIONS The majority of patients undergoing primary palatal repair do not develop palatal fistulas.

Frequency of pharyngoplasty after primary repair of cleft palate in northern Finland

OBJECTIVE One measure of primary cleft palate repair success is the subsequent need for secondary pharyngoplasty due to velopharyngeal insufficiency. This study aimed to assess primary palatoplasty outcomes and frequency of secondary pharyngoplasty. STUDY DESIGN A total of 138 patients underwent palatoplasty between 1998 and 2011. All patients were treated with 1-stage palatoplasty closing the hard and soft palate concurrently. RESULTS Overall frequency of pharyngoplasty after palatoplasty was 21% of patients. The rate of secondary surgery was significantly higher for girls (27%) than for boys (13%). Patients with cleft lip and palate were more likely to require secondary pharyngoplasty (24%) than the patients with soft and hard cleft palate (20%). Surgical technique and cleft severity were significant factors for secondary surgery. Pharyngoplasty was least common in patients whose palatal clefts were treated at 9 to 12 months of age. CONCLUSIONS The majority of patients undergoing primary palatal repair do not need secondary pharyngoplasty.

Midfacial Distraction Osteogenesis

George K.B. Sándor, MD, DDS, PhD, Dr. Habil, FRCDC, FRCSC, FACS*, Leena P. Ylikontiola, DDS, PhD, Willy Serlo, MD, PhD, Pertti M. Pirttiniemi, DDS, PhD, Robert P. Carmichael, DMD, MSc, FRCDC Faculty of Dentistry, University of Toronto, 124 Edward Street, Toronto, Ontario M5G 2M7, Canada The Hospital for Sick Children, S-525, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada Bloorview Kids Rehab, Suite 2E-285, 150 Kilgour Road, Toronto, Ontario M4G 1R8, Canada Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario M5G 1P6, Canada Regea Institute for Regenerative Medicine, University of Tampere, Biokatu 12, Tampere 33520, Finland Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Oulu, Box 5281, Oulu 90014, Finland Institute of Dentistry, University of Oulu, Oulu University Hospital, Box 5281, FIN-90014, Oulu, Finland Division of Pediatric Surgery, Department of Pediatric Surgery, University of Oulu, Oulu University Hospital, Box 23, FIN-90029 OYS, Oulu, Finland

Comparison of Oral Health–Related Quality of Life Among Schoolchildren With and Without Cleft Lip and/or Palate

Objective The aim was to compare the oral health–related quality of life among 11- to 14-year-old patients with cleft lip and/or palate (CLP) and schoolchildren without CLP. The validity and reliability of the Finnish Child Perception Questionnaire designed for 11- to 14-year-olds (CPQ11-14) was also assessed. Design and Subjects Participants in this cross-sectional questionnaire survey study were children aged 11 to 14 years from two groups. The CLP sample included all children of this age who had had CLP selected from the regional treatment register (N = 51). The school sample included children from four school classes (N = 82). Informed consent from parents was obtained. Ethical clearance and parental informed consent were obtained. Main Outcome Measures Oral health–related quality of life was measured with the CPQ11-14. Results The CPQ11-14 total and oral symptoms, functional limitations, emotional well-being, and social well-being subscores were poorer among patients with CLP than among schoolchildren without CLP (mean scores: 55.5 versus 15.0; 11.9 versus 5.1; 14.0 versus 2.8; 12.6 versus 4.2; and 17.1 versus 2.9, respectively; all P < .001 for Mann-Whitney tests). Cronbach alpha value was 0.97 for total scale and between 0.81 and 0.94 for subscales. Among all children in the school sample, intraclass correlation coefficient was 0.79 for total scale and varied between 0.65 and 0.74 for subscales. Conclusion The oral health–related quality of life of Finnish children with CLP was considerably poorer than that of their peers in overall and all dimensions, especially social well-being. The CPQ11-14 showed appropriate reliability and validity.

Maxillary arch dimensions in cleft infants in Northern Finland

Abstract Objective. The aim of this study was to examine the maxillary arch dimensions in cleft lip and/or palate infants in Northern Finland before surgery. Materials and methods. The subjects consisted of 70 Finnish cleft patients born between 1997–2004 in Northern Ostrobothnia Hospital District in Finland. The study casts were obtained before surgery at the mean age of 5.6 months (SD = 2.2). There were 42 children with cleft palate (CP) (26 girls/16 boys), 13 with unilateral cleft lip and palate (UCLP) (eight girls/five boys), eight children with cleft lip (CL)(two girls/six boys) and seven with bilateral cleft lip and palate (BCLP) (two girls/five boys). Conventionally-used landmarks were marked on study casts and cleft width, arch circumference, anterior and posterior arch width and arch length were measured with a digital sliding calliper. The statistical method was ANOVA. Results. The prevalence of CP in this study, 60% of all clefts, is higher than the average standards. There were statistically significant differences in cleft width, posterior and anterior arch width, arch length and arch circumference, when different cleft groups were compared. When differences between girls and boys were compared, boys had larger cleft size and arch dimensions generally, but the results were not statistically significant. Conclusions. The results show the large variation in the severity of cleft lip and/or palate deformity at birth and in maxillary arch dimensions between different cleft types. It also demonstrates the effect of phenotypic variability within the groups of cleft lip and/or palate.

Chronic sclerosing osteomyelitis of the mandible in monozygotic twins.

Identical female twins with chronic sclerosing osteomyelitis of the mandible are presented. The diagnoses of both at the age of 12 years were based on typical history, and on clinical, radiographic, and histologic findings. High concentrations of IgA and IgG were detected in the serum of both patients, but deviations were not observed in other immunologic variables. The normally commensal organism, Propionibacterium acnes grew from a bone biopsy specimen from the mandible of one twin. No oral focus of the disease was confirmed in either case. We suggest that hereditary factors must have played a role in the pathogenesis of these cases of chronic osteomyelitis.

Middle ear findings and need for ventilation tubes among pediatric cleft lip and palate patients in northern Finland.

PURPOSE Middle ear problems are common in cleft patients. This study aimed to determine the need for ventilation tubes (VTs) and complications such as tympanic perforation and cholesteatoma. MATERIAL AND METHODS Data of 156 children with clefts managed in northern Finland spanning 15 years from 1997 to 2011 were collected from 6 hospitals. The following were recorded: birth date, gender, cleft type, surgery timing, surgery type, number of tube insertions, tube material, middle ear findings, and tube placement timing. Clefts were divided into 4 groups: cleft palate (CP), cleft lip and palate (CLP), cleft lip (CL), and submucous cleft palate. The prevalence of middle ear findings was reported. RESULTS Mucous secretion was noted in 96.8% of CLP patients, 69.2% of CP patients, and 13.0% of CL patients. In all, 82.7% of study group had 1 or more VTs placed during follow-up. All CLP patients required more than 1 VT placement. A total of 94.5% of CP patients required VTs compared to 13.0% of CL patients. In the presence of residual oral nasal fistula, the mean number of tube insertions was 5.3. The prevalence of tympanic perforations in clefts was 35.9% and cholesteatoma in 2.6% of patients. CONCLUSIONS CLP and isolated CP patients have frequent middle ear infections requiring multiple VT placements.

The association of cleft severity and cleft palate repair technique on hearing outcomes in children in northern Finland.

BACKGROUND The consequences of cleft lip and palate include scaring, dental malformations, tooth misalignment, speech problems, and hearing loss. Otitis media with effusion causing hearing loss is a problem for many cleft palate patients. METHODS This study examines the association among cleft severity, palate repair technique, and hearing outcomes in children from northern Finland with clefts, aged 3-9 years. The study included 90 cleft patients who were treated at the Oulu University Hospital Cleft Lip and Palate Center between 1998 and 2011. The severity of the cleft, the surgical technique used to repair the palate, audiogram configuration data, and the need for ventilation tube placement were determined retrospectively from patient records. RESULTS Only 3.3% of cleft patients had an abnormal pure tone average hearing threshold representing abnormal hearing. Neither the surgical technique used to repair the cleft palate nor the severity of the cleft was a significant factor related to hearing loss or to the number of ventilation tubes required. Hearing improved significantly with increasing age over a span of 6 years. CONCLUSIONS Continuous follow-up with proactive placement of ventilation tubes before or at the time of palatoplasty results in hearing outcomes in cleft children that are similar to those reported in non-cleft children.