Stephen Shusterman

The Effects of Active Infant Orthopedics on Occlusal Relationships in Unilateral Complete Cleft Lip and Palate

OBJECTIVE To evaluate the effects of active infant orthopedic treatment on dental arch relationships and determine the effect on maxillary growth in children born with unilateral complete cleft lip and palate (UCCLP). DESIGN The GOSLON Yardstick was used to assess dental models taken on patients treated with and without active infant orthopedics. PATIENTS Two groups of nonsyndromic Caucasian children born with UCCLP (total n = 40), all treated by the same surgeon and ranging from 5 to 10 years of age, were evaluated. INTERVENTIONS One group had a Latham dentomaxillary alignment (DMA) appliance inserted at 5 to 6 weeks of age, after which a lip-nasal adhesion was performed at an average age of 3.5 months. This was followed by more definitive nasolabial repair at the average age of 5.9 months. Those patients treated without preoperative orthopedics underwent a lip-nasal adhesion at average age 1.5 months followed by nasolabial repair at average age 5.1 months. MAIN OUTCOME MEASURES Randomized assessments using the GOSLON Yardstick were done independently at two separate times by three different examiners. Differences in GOSLON scores between the active orthopedic group and nonorthopedic group were evaluated by both categorical and continuous statistical analyses. RESULTS The mean GOSLON score was 3.30 for the orthopedic group and 3.21 for the nonorthopedic group. There was no significant group difference in the modal scores of the two groups. CONCLUSIONS This study showed that active infant orthopedics does not affect the dental arch relationships in preadolescent children with repaired UCCLP, compared with a similar group treated without orthopedic intervention at this center.

Emergency management of oral trauma in children.

Oral trauma continues to be a common pediatric emergency, accounting for 150 emergency room dental consultations per year at Childrens Hospital in Boston. Children between the ages of 18 months and 2.5 years and between 8 and 11 years are most at risk. Recent advances in the management of these dental emergencies may help children and their families avoid the psychological and financial cost of infection or loss of primary and permanent teeth. Treatment of avulsions in the young permanent dentition remains a common problem, and a universally accepted approach to its management is still evolving. The use of a doxycycline immersion prior to reimplantation by the dentist may be helpful in preventing external root resorption. As always, the best therapy against dentofacial trauma is the pediatricians support of preventive measures.

Classification of Cleft Lip/Palate: Then and Now:

Cleft lip and/or palate (CL/P) is phenotypically diverse, making classification difficult. This article explores the evolution of ideas regarding CL/P classification and includes the schemes described by Davis and Ritchie (1922), Brophy (1923), Veau (1931), Fogh-Andersen (1943), Kernahan and Stark (1958), Harkins et al. (1962), Broadbent et al. (1968), Spina (1973), and others. Based on these systems, a longhand structured form is proposed for describing CL/P in a way that is clear, comprehensive, and consistent. A complementary shorthand notation is also described to improve the utility and convenience of this structured form.

Clinician's Primer to ICD-10-CM Coding for Cleft Lip/Palate Care

On October 1,2015, the United States required use of the Clinical Modification of the International Classification of Diseases, 10th Revision (ICD-10-CM) for diagnostic coding. This primer was written to assist the cleft care community with understanding and use of ICD-10-CM for diagnostic coding related to cleft lip and/or palate (CL/P).

Operative and Immediate Postoperative Outcomes of Using a Latham-Type Dentomaxillary Appliance in Patients With Unilateral Complete Cleft Lip and Palate

Objective The objective of this study is to examine the operative and immediate postoperative effects of the use of a dentomaxillary appliance (DMA). Design Retrospective chart review of 40 treated patients with unilateral complete cleft lip and palate who had a comprehensive set of pre-, peri-, and postoperative records. Setting Boston Childrens Hospital. Patients Forty treated patients with unilateral complete cleft lip and palate. Interventions Use of DMA. Main Outcome Measures Outcome variables of interest included cleft lip width reduction following use of DMA and odds of having primary gingivoperiostetoplasty (GPP). Results The study sample included 40 subjects (31 boys and 9 girls). The average age at the time of DMA insertion was 11 weeks. The average width of the alveolar cleft prior to DMA insertion was 10.77 mm. The mean cleft width reduction was 8.66 mm. Each 1-mm increase in pre-DMA cleft width was associated with a 0.631-mm reduction in cleft width (P < .001). Thirty-three patients (82.5%) had a GPP procedure. Each 1-mm increase in post-DMA width was associated with a lower odds of having a GPP (odds ratio = 0.32, 95% confidence interval = 0.14–0.77, P = .01). Conclusions Post-DMA width was the significant factor associated with the performance of GPP. The use of DMA is associated with a significant reduction in the width of the cleft, and outcomes are predictable without any major adverse events or complications.

Effect of infant surgical orthopedic treatment on facial growth in preadolescent children with unilateral and bilateral complete cleft lip and palate

OBJECTIVE To examine the impact of dentofacial infant orthopedic treatment (DFIO) on facial growth in preadolescent children with unilateral complete cleft lip and palate (UCCLP) and bilateral complete cleft lip and palate (BCCLP). METHODS This is a retrospective study of patients with UCCLP and BCCLP treated at a single center. The treatment group had DFIO, and the control group did not have DFIO. Regression models were used to compare outcomes between the study and control groups. RESULTS The study sample comprised 81 patients (54 had DFIO and 27 did not have DFIO). Among those with UCCLP, those who had DFIO had a shorter maxillary length (-2.12 mm; P = .04) and shorter lower anterior facial height (-2.77 mm; P = .04) compared with controls. Among those with BCCLP, there were no significant differences between the treatment and control groups. CONCLUSIONS DFIO treatment could result in shorter maxillary length and lower anterior facial height in those with UCCLP.

Assessment of morbidity following insertion of fixed preoperative orthopedic appliance in infants with complete cleft lip and palate

OBJECTIVE To examine physiologic and behavioral indicators of pain within the first 24 hours following insertion of the fixed presurgical orthopedic appliance (FPOA) under general anesthesia in infants with unilateral and bilateral complete cleft lip and palate. METHODS The study sample included 109 infants who had either a dentomaxillary appliance (DMA) or an elastomeric chain premaxillary retraction (ECPR) appliance. Vital signs and FLACC (Face, Legs, Activity, Cry, Consolability) scores were used to measure the outcomes. RESULTS There was an initial postoperative increase in the median heart rate. Heart rate returned to the median baseline level by 8 hours. The median systolic blood pressure increased postoperatively and remained elevated throughout the time of evaluation. The median respiratory rate remained below that at baseline throughout the study period. The highest mean change in FLACC measurements was observed approximately 2 hours postoperatively. By 3 hours postoperatively, the scores decreased. CONCLUSIONS Although there was a large individual variability, the FLACC scores became reduced after 3 hours following surgical insertion of the DMA and the ECPR appliance.