Rita de Cássia Moura Carvalho Lauris

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) Part 4: Oral Rehabilitation

Treatment of patients with cleft lip and palate is completed with fixed prostheses, removable, total, implants and aims to restore aesthetics, phonetics and function and should be guided by the basic principles of oral rehabilitation, such as physiology, stability, aesthetics, hygiene and the expectations of the patient. In order to obtain longevity of a prosthetic rehabilitation, the periodontal and dental tissue as well as the biomechanics of the prosthesis are to be respected. The purpose of this article is to describe the types of prosthetics treatment, which are performed at HRAC/USP for the rehabilitation of cleft area in adult patients.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies - USP (HRAC-USP) - Part 2: Pediatric Dentistry and Orthodontics

The aim of this article is to present the pediatric dentistry and orthodontic treatment protocol of rehabilitation of cleft lip and palate patients performed at the Hospital for Rehabilitation of Craniofacial Anomalies - University of São Paulo (HRAC-USP). Pediatric dentistry provides oral health information and should be able to follow the child with cleft lip and palate since the first months of life until establishment of the mixed dentition, craniofacial growth and dentition development. Orthodontic intervention starts in the mixed dentition, at 8-9 years of age, for preparing the maxillary arch for secondary bone graft procedure (SBGP). At this stage, rapid maxillary expansion is performed and a fixed palatal retainer is delivered before SBGP. When the permanent dentition is completed, comprehensive orthodontic treatment is initiated aiming tooth alignment and space closure. Maxillary permanent canines are commonly moved mesially in order to substitute absent maxillary lateral incisors. Patients with complete cleft lip and palate and poor midface growth will require orthognatic surgery for reaching adequate anteroposterior interarch relationship and good facial esthetics.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) - Part 5: Institutional outcomes assessment and the role of the Laboratory of Physiology

The Laboratory of Physiology provides support for the diagnosis of functional disorders associated with cleft lip and palate and also conducts studies to assess, objectively, the institutional outcomes, as recommended by the World Health Organization. The Laboratory is conceptually divided into three units, namely the Unit for Upper Airway Studies, Unit for Stomatognathic System Studies and the Unit for Sleep Studies, which aims at analyzing the impact of different surgical and dental procedures on the upper airways, stomatognathic system and the quality of sleep of individuals with cleft lip and palate. This paper describes the main goals of the Laboratory in the assessment of procedures which constitute the basis of the rehabilitation of cleft lip and palate, i.e., Plastic Surgery, Orthodontics and Maxillofacial Surgery and Speech Pathology.

INFLUENCE OF ISOLATED CLEFT PALATE AND PALATOPLASTY ON THE FACE

Introduction The literature has demonstrated that alterations in craniofacial morphology characterizing individuals with cleft palate are observed in both operated and unoperated patients. Objective This study evaluated the influence of isolated cleft palate and palatoplasty on the face, based on facial analysis. Material and methods Lateral facial photographs of the right side of 85 young adult patients with cleft palate were analyzed, of whom 50 were operated on and 35 had never received any previous surgical treatment. The nasolabial angle and zygomatic projection were used to define the maxillary position in the face. Mandibular positioning was classified as Pattern I, II and III. Results Patients were distributed into 54.12% as Pattern I, 32.94% Pattern II and 12.94% Pattern III. Distribution of facial patterns did not show statistically significant differences between groups (p>0.05). Although palatoplasty did not influence the facial pattern, the zygomatic projection was vulnerable to plastic surgeries. Twenty-eight percent of the patients in the operated group showed zygomatic deficiency, compared to only 8.5% in the unoperated group. Conclusions In patients with isolated cleft palate, palatoplasty may influence negatively the sagittal behavior of the maxilla, according to the zygomatic projection of the face, though without compromising the facial pattern.

Prevalence of dental anomalies of number in different subphenotypes of isolated cleft palate

Objective This study aimed at carrying out a radiographic analysis on the prevalence of dental anomalies of number (agenesis and supernumerary teeth) in permanent dentition, in different subphenotypes of isolated cleft palate pre-adolescent patients. Methods Panoramic radiographs of 300 patients aged between 9 and 12 years, with cleft palate and enrolled in a single treatment center, were retrospectively analyzed. The sample was divided into two groups according to the extension/severity of the cleft palate: complete and incomplete . The chi-square test was used for intergroup comparison regarding the prevalence of the investigated dental anomalies (P < 0.05). Results Agenesis was found in 34.14% of patients with complete cleft palate and in 30.27% of patients with incomplete cleft palate. Supernumerary teeth were found in 2.43% of patients with complete cleft palate and in 0.91% of patients with incomplete cleft palate. No statistically significant difference was found between groups with regard to the prevalence of agenesis and supernumerary teeth. There was no difference in cleft prevalence between genders within each study group. Conclusion The prevalence of dental anomalies of number in pre-adolescents with cleft palate was higher than that reported for the general population. The severity of cleft palate did not seem to be associated with the prevalence of dental anomalies of number.

Relationship between occlusion and lisping in children with cleft lip and palate.

Introduction The literature suggests that individuals with history of cleft lip and palate who present with midfacial growth deficiency are at higher risk of presenting lisping. The relationship between distortions during production of linguoalveolar fricative sounds and the severity of malocclusion, however, has not been established for the population with cleft. Objective To study the association between lisping and dental arch relationship. Methodology Speech samples and dental arch casts were obtained from 106 children with operated unilateral cleft lip and palate (UCLP) during the stage of mixed dentition and before orthodontic treatment. Videotaped productions of the phrase lu saci saiw sedul were rated by speech-language pathologists for the identification of lisping during [s]. Dental arch casts were rated by orthodontists using the Goslon Yardstick and the Five-Year Index to establish dental arch relationship. Results Multiple logistic regression showed no significant association between lisping and dento-occlusal index (p = .802) and age (p = .662). Substantial interjudge agreement during auditory-perceptual ratings was found (kappa = .63). Almost perfect agreement was found between orthodontists while establishing the dental arch relationship (kappa = .81). Discussion This study failed to reveal an association between lisping and dental arch relationship in children with operated UCLP. Multiple variables may play a role in determining occurrence of lisping, warranting further investigation.

Evaluation of Facial Esthetics in Rehabilitated Adults with Complete Unilateral Cleft Lip and Palate: A Comparison between Professionals with and without Experience in Oral Cleft Rehabilitation

Objectives. The aim of this study was to evaluate the facial esthetics of White-Brazilian adults with complete unilateral cleft lip and palate (UCLP) rehabilitated at a single center. Design. 30 patients (13 females; 17 males; mean age of 24.0 years), rehabilitated at a single center, were photographed and evaluated by 25 examiners, 5 orthodontists, and 5 plastic surgeons dealing with oral clefts, 5 orthodontists and 5 plastic surgeons with no experience in the cleft treatment, and 5 laymen. Their facial profiles were classified into esthetically unpleasant, esthetically acceptable, and esthetically pleasant. Results. Orthodontists dealing with oral clefts classified the majority of the sample as esthetically pleasant. Plastic surgeons dealing with oral cleft, orthodontists, and plastic surgeons without experience with oral clefts classified most of the sample as esthetically acceptable. Laymen evaluation also considered the majority of the sample as esthetically acceptable. Conclusions. The facial profiles of rehabilitated adults with UCLP were classified mostly as esthetically acceptable, with variations among the categories of examiners. The examiners dealing with oral clefts gave higher scores to the facial esthetics when compared to professionals without experience in oral clefts and laypersons, probably due to their knowledge of the limitations involved in the rehabilitation process.

Facial profile esthetics in operated children with bilateral cleft lip and palate

ABSTRACT Objective: The aim of this study was to evaluate the facial profile esthetics of rehabilitated children with complete bilateral cleft lip and palate (BCLP), comparing the judgment of professionals related and not related to cleft rehabilitation and laypersons. Methods: Thirty children in the mixed dentition (24 male; 6 female) with a mean age of 7.8 years were evaluated using facial profile photographs by 25 examiners: 5 orthodontists and 5 plastic surgeons with experience in cleft care, 5 orthodontists and 5 plastic surgeons without experience in oral cleft rehabilitation and 5 graduated laymen. Their facial profiles were classified into esthetically unpleasant (grade 1 to 3), esthetically acceptable (grade 4 to 6), and esthetically pleasant (grade 7 to 9). Intraexaminer and interexaminer errors were evaluated using Spearman correlation coefficient and Kendall’s test, respectively. Inter-rater differences were analyzed using Friedman test and Student-Newman-Keuls test for multiple comparisons. Results: Orthodontists dealing with oral clefts rehabilitation considered the majority of the sample as esthetically pleasant. Plastic surgeons of the cleft team and laypersons classified most of the sample as esthetically acceptable. Most of the orthodontists and plastic surgeons not related to cleft care evaluated the facial profile as esthetically unpleasant. The structures associated to unpleasant profiles were the nose, the midface and the upper lip. Conclusions: The facial profile of children with BCLP was classified as esthetically acceptable by laypersons. Professionals related to cleft rehabilitation were more lenient and those not related to cleft care were stricter to facial esthetics than laypersons.

Ocorrência de ceceio em fricativas vozeadas e não vozeadas em crianças com fissura labiopalatina operada

Purpose to investigate whether lisp, when identified, differs between voiced and unvoiced alveolar fricatives produced by children with cleft palate. Methods a prospective study in which sentences comprising the consonants [s] and [z] produced by 32 children with cleft palate (mean age, 8 years, 8 months) were selected and after auditory judged. All children presented altered inter-relationship arches as evaluated by three orthodontists (inter-judge agreement almost perfect kappa = 0.81), performing analysis of dental casts. Three Speech-Language-Pathologists judged perceptually audio recorded productions. The inter-judges agreement ranged between 56% and 78% and between 59% and 93% for the phrases consisting of [s] and [z], respectively. Results the lisp was identified in 69% of children, particularly, in 72% and 50% [s] and [z] sounds, respectively. There were significant differences between judgments for the fricatives [s] and [z], with higher prevalence of lisping in [s]. Conclusions dentofacial deformities may favor the occurrence of lisp in population with cleft palate. The increased occurrence of lisp in [s] compared to [z], based on auditory perceptual identification, can be justified by acoustic and / or articulatory reasons. It is suggested that lisp is dependent of the phonetic-phonological context of the sentence and therefore must be considered for clinical and research purposes.

Facial pattern of patients with post-foramen incisor cleft

OBJETIVO: avaliar e determinar o padrao de crescimento facial de individuos com fissura pos-forame incisivo. METODOS: esse estudo transversal retrospectivo usou fotografias frontais e de perfil de uma amostra de 71 pacientes matriculados no HRAC-USP (Bauru/SP), sendo 22 individuos do sexo masculino e 49 do feminino, jovens adultos brasileiros, com idade media de 17 anos e 8 meses, sem tratamento ortodontico previo ou sindromes associadas. O metodo utilizado foi o diagnostico facial subjetivo, baseado em conceitos tecnicos, constando da analise morfologica qualitativa da face. Os individuos foram classificados, por dois ortodontistas do HRAC/USP, com base no conceito de padrao sugerido por Capelozza Filho: Padrao I, II, III, Face Longa e Face Curta. RESULTADOS: a distribuicao na analise morfologica frontal encontrada foi: Padrao I (69%), Padrao II (6%), Padrao III (7%), Padrao Face Longa (18%) e Padrao Face Curta (0%). Na analise morfologica de perfil, a distribuicao encontrada foi: Padrao I (35%), Padrao II (38%), Padrao III (10%), Padrao Face Longa (17%) e Padrao Face Curta (0%). A distribuicao no aspecto frontal foi muito positiva, ja que os individuos Padrao I predominaram. Na analise do perfil, as displasias anteroposteriores foram expressas em essencia, aumentando significativamente sua participacao. Ja o Padrao Face Longa manteve um equilibrio em ambas as avaliacoes e o Padrao Face Curta nao foi encontrado na amostra utilizada, provavelmente devido a baixa prevalencia na populacao geral. CONCLUSAO: a prevalencia dos diversos padroes faciais para os pacientes com fissura pos-forame incisivo foi semelhante a encontrada para individuos sem fissura.