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The assessment of rehabilitation outcomes requires a patient documentation protocol, including records obtained at standardized ages, to compare different types of surgeries, their effects, as well as between different rehabilitation centers. The aim of this paper was to present proper trays for babies with different types of cleft lip and palate, which are used in the outpatient routine at Hospital of Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP). The customized trays are made with self-curing acrylic resin. The tray must have suitable depth to copy the buccal sulcus, and wax is usually applied to contour the tray edge, and the adjustment of the tray to the fornix, making the tray specific for each child. The impression precludes the utilization of dental casts for diagnosis, treatment plan, and research measurements. In the clinical practice at HRAC-USP, it was observed that customized trays increased the quality of impression, accurately reproducing anatomical features of dental arches of babies with oral clefts.

Statement of Problem: Patients with cleft lip and palate generally present with lateral incisor agenesis, which may be treated with an implant-supported prosthesis. However, whether implants can stabilize the dental arches in patients with cleft lip and palate is unclear., Purpose: The purpose of this retrospective clinical study was to analyze the stability of the maxillary dental arch after orthodontic treatment and oral rehabilitation in the cleft area with an implant-supported prosthesis or a fixed partial denture., Material and Methods: Fifty-five participants, 20 with unilateral cleft lip and palate rehabilitated with implants (CLPI), 15 with unilateral cleft lip and palate rehabilitated with fixed partial dentures (CLPFP), and 20 in the noncleft group (NCLP) and their gypsum casts (N=110) were digitized and evaluated through 3D stereophotogrammetry. Measurements were made on casts obtained immediately after the orthodontic treatment (T1); for the cleft lip and palate group, casts were made 1 year after implant-supported restoration placement (T2), and for the noncleft group, 1 year after the conclusion of the orthodontic treatment (T2). The dimensions of the dental arches were measured digitally. Formula Δ=T2-T1 evaluated the stability of dental arches for intercanine distances, intermolar distances, arch length, palate surface, and volume (3D). Stability (Δ) was compared through 1-way ANOVA in all groups (α=.05)., Results: A statistically significant difference was found in the stability of the CLPI and CLPFP groups for intercanine measurement (P=.002). For the intermolar measurement, a statistically significant difference was detected between the CLPFP and NCLP groups (P=.002). From the 3D measurements, the stability was similar in all groups., Conclusions: In patients with clefts, a fixed partial denture may provide better stability of the orthodontic outcomes than an implant-supported prosthesis. However, greater instability occurred at the molar area., (Copyright © 2020 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

We aimed to evaluate the treatment protocols for cleft lip and palate that are used in Brazil, to compare them with the ones proposed from elsewhere, and to discuss the official data about admission for treatment of cleft lip or palate, or both, in Brazil. We also assessed the importance of integrated action of different specialities to treat this condition. A questionnaire related to attendance protocols was developed and sent out to all Brazilian Plastic Surgery Services connected to the Brazilian Society of Plastic Surgery, and to other units involved in such treatment. We also studied the data produced by the Brazilian Department of Health about the operations done during the past five years. Many protocols were identified, but despite much controversy in many areas, a consensus was reached about the surgical techniques, the age group most suitable to be operated on, and there was total agreement about the need for multidisciplinary management. According to the State Department of Health, the number of operations done in 1995 was 9696, and this had increased to 21 022 in 1999. The state of São Paulo had done 17 636 (84%) of all procedures in 1999. [ABSTRACT FROM AUTHOR]

In this study, we investigated brain morphological changes in adults with non-syndromic cleft lip and palate (NSCLP) after articulation rehabilitation (AR). High-resolution T1 weighted brain magnetic resonance imaging data were analyzed from 45 adults with NSCLP after palatoplasty: 24 subjects were assessed before AR (bNSCLP) and 21 subjects were assessed after AR (aNSCLP). In addition, there were 24 age and sex matched controls. Intergroup differences of grey matter volume were evaluated as a comprehensive measure of the cortex; cortical thickness and cortical complexity (gyrification and fractal dimensions) were also analyzed. As compared to controls, the bNSCLP subjects exhibited altered indexes in frontal, temporal, and parietal lobes; these morphological changes are characteristic for adults with NSCLP. Importantly, as compared to the bNSCLP and control subjects, the aNSCLP subjects exhibited cortical plasticity in the regions involved in language, auditory, pronunciation planning, and execution functions. The AR-mediated cortical plasticity in aNSCLP subjects may be caused by AR-induced cortical neurogenesis, which might reflect the underlying neural mechanism during AR.

Objectives: workshops and specialized training programs are often inaccessible for speech and language pathologists (SLPs) based in resource-limited countries given the lack of supply, the long travel distances and the excessive participation fees. To stimulate life-long learning opportunities for all, this study described and measured the effect of a free, two-day cleft care workshop for SLPs in Uganda. The workshop included different topics related to the assessment and treatment of children with a cleft of the palate with or without a cleft of the lip (CP ± L)., Methods: The participants who presented during the two-day course were asked to complete a pre- and post-workshop questionnaire to evaluate their satisfaction. The pre-workshop form also included some questions concerning cleft care in Uganda. Both the pre- and post-workshop forms included three visual analogue scales to investigate the evolution of the participants' estimation of their knowledge regarding speech in patients with a CP ± L and to assess the changes in their self-confidence in the diagnosis and treatment of this population., Results: seventeen SLPs completed the pre- and post-workshop questionnaires. In general, the participants were highly satisfied with the different themes covered in the program. After the training course, the participants rated their general knowledge about CP ± L and their self-confidence in the diagnosis and treatment of children with a CP ± L significantly higher than before the workshop., Conclusion: the vast majority of the SLPs reported that cleft care was not easily accessible in Uganda. The most commonly reported obstacle for cleft care was a lack of knowledge about this matter in the SLPs themselves highlighting the importance of the organization of additional education opportunities. The participants reported a significantly higher level of self-confidence in diagnosing and treating children with a CP ± L after the workshop. The content of this workshop can form the basis for future learning opportunities for SLPs based in resource-limited countries., Competing Interests: Declaration of competing interest There is no conflict of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Craniofacial interventions are common and the surgical options continue to grow. The issues encountered include micrognathia, macroglossia, midface hypoplasia, hearing loss, facial nerve palsy, hemifacial microsomia, and microtia. In addition, a unifying theme is complex upper airway obstruction. Throughout a child's life the focus of interventions may change from airway management to speech, hearing, and language optimization, and finally to decannulation and procedures aimed at social integration and self-esteem. Otolaryngologists play an important role is this arena and provide high-quality care while continuing to expand what can be done for our patients., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background/aims: In resource-limited countries, traditional models for speech therapy delivery are not adequate to reach all patients in need. In those countries, intensive speech therapy might be a solution. Preliminary results of previous research demonstrated that intensive speech therapy can be effective in the short term for patients living in countries with limited access to speech therapy. Questions might arise whether or not intensive treatment results in long-term benefits for these patients. Hence, the present study investigated long-term effectiveness of intensive speech therapy provided to Ugandan patients born with a cleft palate with or without cleft lip (CP ± L) in terms of different speech characteristics., Methods: Five Ugandan patients with CP ± L, who received intensive speech therapy in the past, were contacted to participate in this follow-up study. All patients agreed to participate. Perceptual and instrumental speech evaluations were performed identically to the assessments immediately before and after speech therapy, to allow for comparison. Additionally, the Cleft Evaluation Profile, investigating self-perceived satisfaction with cleft-related features was included to compare satisfaction before and after speech therapy., Results: Long-term improvement in percentage correct consonants was seen in four patients. Furthermore, after speech therapy, decreased presence of resonance disorders was observed in two of the included patients. Before speech therapy, all participants were dissatisfied with speech. Interestingly, after intensive speech therapy, satisfaction with speech was seen in every patient and this satisfaction remained in the long term., Conclusion: In summary, speech improvements after speech therapy varied among the five patients. Nevertheless, present study provided encouraging results to further investigate effectiveness of intensive speech therapy in patients with CP ± L., (Copyright © 2019 Elsevier B.V. All rights reserved.)

This study aimed to compare the linear dimensions of the dental arches of adult patients with complete unilateral cleft lip and palate (UCLP) after orthodontic and prosthetic treatment with fixed partial dentures (FPD) to patients without clefts, using 3D technology. This retrospective longitudinal study sample consisted of 35 subjects divided into two groups. Included in this sample were 15 complete UCLP individuals who had received orthodontic treatment before rehabilitation with a fixed partial denture (FG), as well as 20 patients without cleft as control group (CG). All patients were aged between 18 and 30 years. Digital dental casts were obtained in two stages: (T1) end of orthodontic treatment and (T2) one year after prosthetic rehabilitation (FG); and (T1) end of orthodontic treatment and (T2) one year after removal of the orthodontic appliance (CG). Intercanine, interfirst premolar and intermolar distances, and incisor-molar length were obtained. A precalibrated and trained examiner performed the assessments. Intergroup differences between T2 and T1 were compared between the groups using the t test or Mann-Whitney test with a significance level of 5% (p<0.05). The intercanine distance variation (T2-T1) showed statistical difference (p=0.005) increasing in the FG group and decreasing in the CG group. In the interfirst premolar distance variation, FG decreased, while CG increased with statistically significant difference (p=0.008). The intercanine distance of individuals with cleft showed stability, while that of the CG had no stability. The CG showed stability in the interfirst premolar distance, while FG had no stability. These findings showed that the FPD is capable of restricting orthodontic results, leading to a stabilization of the dental arches.

The multidisciplinary teams involved in the treatment of individuals with cleft lip and palate are challenged when implants are indicated in the cleft area. Difficulties include obtaining a healthy peri-implant area and, especially, obtaining the natural-looking papilla essential for esthetic success. The area affected by the cleft has a bone deficiency, which is typically augmented with an alveolar bone graft at adolescence. Guidelines for the 3-dimensional placement of implants at the cleft area are presented based on clinical reports. The patients were followed up for at least 1 year. Adoption of the proposed guidelines enables satisfactory esthetic and functional outcomes in patients with cleft lip and palate., (Copyright © 2018 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

The impact of oral rehabilitation on masticatory function and oral health-related quality of life (OHRQoL) may vary with the experience of the individual with tissue loss. Our hypothesis is that patient-centered outcomes vary among adults who have experienced large defects in the maxilla due to congenital or acquired conditions even after oral rehabilitation to restore aesthetics and function. This study compared OHRQoL, perceived masticatory ability, maximum bite force (MBF), and symptoms of pain and depression among subjects with acquired (edentulous maxilla) and congenital (cleft lip and palate) loss of oral tissues in the maxilla after dental treatment. A gender-matched sample (n = 60) of cleft lip and palate (CLP), maxillary denture wearers (DENT) and controls (CONT) was recruited. OHRQoL was assessed using OHIP-14. Chewing was evaluated through a masticatory ability questionnaire and by MBF. The RDC/TMD Axis II questionnaire was used to assess symptoms of pain and depression. Data were analyzed by Fisher's test, Kruskal Wallis test, and Spearman correlation coefficients. CLP showed higher OHIP-14 and depression scores than DENT and CONT (p < 0.05). Sub-analysis by OHIP-14 items (%FOVO) showed higher prevalence of psychological impact for CLP and of functional impacts for DENT. The number of foods difficult to chew, of food textures difficult to chew, and avoided foods were similar between CLP and DENT. OHIP-14, MBF, and depression scores showed significant correlation (p < 0.05). The results suggest that adults with treated CLP or maxillary DENT have chewing impairment and lower MBF than healthy subjects, with different psychological and functional impacts.

Objective: To investigate the early reading abilities, and related cognitive-linguistic processes, in bilingual children with nonsyndromic cleft lip and/or palate (CL/P), and to identify deficits that might be amenable to intervention., Design and Participants: Bilingual participants with CL/P aged 5 to 6 years who were English-dominant ( n=17) or Mandarin-dominant ( n=18) were recruited using consecutive sampling from a national cleft treatment center and matched pairwise to a sample of typically developing (TD) children on language dominance, age, and socioeconomic status. All participants were assessed in English on single-word reading accuracy using the Wide Range Achievement Test (4th Ed), and key cognitive-linguistic factors associated with reading development: phonological awareness, rapid automatized naming (RAN), receptive and expressive vocabulary, and verbal short-term and working memory., Results: CL/P and TD groups were compared within language dominance group (Mandarin or English) for all measures. The Mandarin-dominant CL/P group had significantly poorer reading accuracy and phonological awareness than their TD peers. Additionally, regardless of language dominance, faster RAN correlated significantly with better reading accuracy in both the CL/P groups but not the TD groups., Conclusions: Children with CL/P who are learning English as a second language are at greater risk of reading difficulties. Furthermore, the cognitive-linguistic processes underlying early reading in bilingual children with CL/P differ from those of their TD peers. Routine screening and tailored intervention is advisable.

Congenital malformations of the maxillofacial area - congenital cleft lip and palate (CCLP) due to their frequency, the severity of anatomical and functional disorders, the difficulty of social adaptation of patients, economic aspects are one of the most important problems of medicine. It is established that for timely stage surgical treatment of children with IAPC the emphasis is on the somatic status of the child, anti-infective resistance, the ability to safely tolerate surgery, which is important for the restoration of anatomical defects, communication functions and psychosomatic health. Children with CCLP are at risk for increased occurrence of postoperative complications, since upper respiratory tract infection and exacerbation of chronic respiratory tract diseases and ENT organs is a contraindication to surgical intervention. The study of immune status revealed deep violations of antiviral and antibacterial immunity in children with CCPC aged from 6 to 12 years. A program of combine interferon- and immunotherapy has been created. Positive clinical and immunological efficacy of combine interferon-(gel Viferon - recombinant IFNα2b in combination with antioxidant) and immunotherapy in the rehabilitation of children with CCPC aged 6 to 12 years was demonstrated.

Objective: To assess the orthodontic burden of care of patients from a Brazilian rehabilitation center (Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo [HRAC-USP])., Design: Retrospective., Setting: Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo., Interventions: One hundred files of unilateral complete cleft lip and palate patients who had consecutively finished orthodontic rehabilitation at HRAC-USP were evaluated from January 2011 to January 2013. The duration of orthodontic treatment, number of visits, kilometers traveled, number of appliances and surgical procedures performed were recorded. The sample was divided into 2 subgroups according to severity the interarch relation (Goslon Yardstick score) at the beginning of orthodontic treatment. Mann-Whitney test was applied for intergroup comparison ( P < .05)., Results: For the total sample (n = 100), the mean time of orthodontic treatment was 140.2 months, the mean number of orthodontic appointments was 61.8, the mean number of appliances was 10, the mean number of surgical procedures was 6.2, and the mean distance traveled to attend the center for orthodontic appointments was 38,978.5 km. The subgroup with the most severe malocclusion (Goslon yardsticks scores 4 and 5) showed a longer orthodontic treatment length, greater number of surgical procedures, and longer distance traveled than those presenting Goslon yardstick scores 1, 2, and 3., Conclusion: Patients with greater severity of the initial malocclusion experienced a higher burden of care than patients with less severity of the initial malocclusion. To reduce the burden of care, research and efforts should focus on minimizing maxillary growth deficiency related to primary surgery.

Objective This study analyzed the maintenance of lateral incisors in the dental rehabilitation of individuals with cleft lip and palate. Material and Methods The study was conducted on a tertiary craniofacial center and comprised retrospective analysis of panoramic and periapical radiographs of Caucasoid individuals with non-syndromic complete unilateral cleft lip and palate, analyzing all radiographs available on the records of each individual, from the first to the last up to 12 years of age. Overall, 2,826 records were reviewed to achieve a sample of 1,000 individuals. Among these, 487 individuals presented the permanent lateral incisors on both cleft and non-cleft sides, which were included in this study. Results The results were evaluated in percentages and by descriptive statistics. The association between maintenance of the lateral incisor and timing of alveolar bone graft were analyzed by the t test. Among the 487 individuals, 265 had not completed treatment, 62 presented insufficient information, and 44 concluded the treatment elsewhere. Among the remaining 116 individuals, the lateral incisor was extracted from 88 (75.86%) of them on the cleft side (CS) and from 23 (19.83%) people on the non-cleft side (NCS). The age at accomplishment of alveolar bone graft was significantly associated with maintenance of the lateral incisor on the cleft side (p<0.01). Most extractions were indicated because of the inadequate positioning on the CS and for midline correction on the NCS. Rehabilitation was primarily completed by orthodontic movement (53 individuals on the CS and 13 individuals on the NCS). Conclusion In conclusion, the lateral incisor on the cleft side was not maintained in most individuals. Positive relationship was observed between extraction of the lateral incisor and age at accomplishment of the alveolar bone graft, suggesting the need to anticipate the initial radiographic evaluation to enhance its maintenance and reduce the procedures required for rehabilitation.

Background: The rehabilitation of patients with cleft deformities is very complex and unique, and managed by a team of professionals. Quality of life depends on the health, and represents an instrument that examines the disease impact and treatment modalities on the health, integrating an objective assessment of the health status and its subjective experience. Children with clefts are often teased by their peers, and that is the reason why they experience different kinds of psychological distress. Patients with non-syndromic clefts may develop depression and anxiety, hyperactivity, elevated risk of suicide and increased drug abuse in adolescence., Subjects and Methods: Experienced members of a cleft palate team developed a specific questionnaire divided into 2 parts: the first contains the clinical profile of adolescents, and the second part contains questions regarding quality of life. This questionnaire was administered to 73 patients between June 2015 and June 2016, who matched these criteria during their control examinations at the University Hospital Dubrava., Results: In general, the patient group showed significantly worse scores on majority of answers, specifying that their quality of life is worse compared to the control group. The principal component analysis revealed the presence of three components (factors). The interpretation of the three components was consistent with loadings indicating the component names: Component 1: The relationship with parents, success, society; Component 2: Appearance, and Component 3: Function., Conclusion: According to our results, we created a specific instrument - The Quality of Life in Adolescents with Cleft Assessment to assess aesthetic and functional results of treatment and quality of life of the operated adolescents with clefts. The adolescents in this study have no psychiatric disorders diagnosed in their medical charts, but results indicate that some of them need help in dealing with future life. Regarding these findings, it will be possible to intervene in the process of treatment and improve the overall outcome of therapy.

This study aimed at monitoring the maxillary growth of children with cleft lip/palate in the first two years of life, and to evaluate the effects of primary surgeries on dental arch dimensions. The sample consisted of the three-dimensional digital models of 25 subjects with unilateral complete cleft lip and palate (UCLP) and 29 subjects with isolated cleft palate (CP). Maxillary arch dimensions were measured at 3 months (before lip repair), 1 year (before palate repair), and at 2 years of age. Student's ttest was used for comparison between the groups. Repeated measures ANOVA followed by Tukey's test was used to compare different treatment phases in the UCLP group. Paired ttest was used to compare different treatment phases in the CP group. P<0.05 was considered statistically significant. Decreased intercanine distance and anterior arch length were observed after lip repair in UCLP. After palate repair, maxillary dimensions increased significantly, except for the intercanine distance in UCLP and the intertuberosity distance in both groups. At the time of palate repair and at two years of age, the maxillary dimensions were very similar in both groups. It can be concluded that the maxillary arches of children with UCLP and CP changed as a result of primary surgery.

The objective of this study was to investigate the prevalence of live births with orofacial clefts in Brazil from 2009 to 2013, according to Brazil's federative units and regions, and correlate it with the number of corrective surgery procedures for cleft lip and palate performed through the Brazilian National Health System in the same period. The data were collected from the National Live Birth System (SINASC in Portuguese) and the Hospital Information System (SIH-SUS in Portuguese). The results showed that the average prevalence of oral clefts in the period was 5.86 per 10,000 live births, with differences observed between the federative units and the regions. The correlation between the prevalence of orofacial clefts and the number of medical procedures associated with this anomaly was statistically significant (r=0.94; p <0.001). This result indicates that greater investments are being made in areas with a higher number of cases. The relationship between supply and demand for corrective surgeries suggests that only 18.91% of the live births with orofacial clefts in this period may have received this service under the Brazilian National Health System.

Objective: The aim of this study was to investigate the impact of an intensive 10-week course of articulation therapy on articulation errors in cleft lip and palate patients who have Velopharyngeal Insufficiency (VPI), non-oral and passive cleft speech characteristics., Methods: Five children with cleft palate (+/-cleft lip) with VPI and non-oral and passive cleft speech characteristics underwent 40 intensive articulation therapies over 10 weeks in a single case experimental design. The percentage of non-oral CSCs (NCSCs), passive CSCs (PCSCs), stimulable consonants (SC), correct consonants in word imitation (CCI), and correct consonants in picture naming (CCN) were captured at baseline, during intervention and in follow up phases. Visual analysis and two effect size indexes of Percentage of Nonoverlapping Data and Percentage of Improvement Rate Difference were analyzed., Results: Articulation therapy resulted in visible decrease in NCSCs for all 5 participants across the intervention phases. Intervention was effective in changing percentage of passive CSCs in two different ways; it reduced the PCSCs in three cases and resulted in an increase in PCSCs in the other two cases. This was interpreted as intervention having changed the non-oral CSCs to consonants produced within the oral cavity but with passive characteristics affecting manner of production including weakness, nasalized plosives and nasal realizations of plosives and fricatives. Percent SC increased throughout the intervention period in all five patients. All participants demonstrated an increase in percentage of CCI and CCN suggesting an increase in the consonant inventory. Follow-up data showed that all the subjects were able to maintain their ability to articulate learned phonemes correctly even after a 4-week break from intervention., Conclusion: This single case experimental study supports the hypothesis that speech intervention in patients with VPI can result in an improvement in oral placements and passive CSCs., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Objective: The main purpose of this study was to analyse the reactions of a panel (non-cleft adults) when observing cleft lip morphology. Although rehabilitation of cleft lip and palate is improving, there are still indications of social rejection of cleft patients by the people around them. Polarity profiles have been used since 1973 to measure social distance with regard to cleft patients. Because rehabilitation results and education of the society have improved in recent decades, we investigated whether social distance has been affected., Setting: The setting of this study is the Department of Oral, Craniomaxillofacial, and Facial Plastic Surgery, University Hospital of Leipzig, Germany, Patients and Participants: Using a cross-sectional study design, we enrolled a sample of adult laypersons (n = 273). For the survey, we followed the concept of photograph presentation and questionnaire investigation reported by Sergl and Schmid (1973). We presented anonymised frontal and profile pictures of the faces of 50 cleft patients and asked the laypersons to specify social distance. Three predictor variables (layperson gender, profession and year of evaluation) were grouped., Results: Although social distance has reduced during the last 40 years, life situations which require emotional proximity still cause some concern. Professional background and gender affect laypersons' attitudes., Conclusion: Although rehabilitation of cleft lip and palate is much better than 40 years ago, social distance remains a problem in society. It is necessary to improve both results of rehabilitation of cleft patients and social acceptance by the people around them.

Abstract Retrospective analysis was conducted in 78 patients of various age, who suffered the inborn lip and palate fissura, for estimation of the patients quality of life after uranostaphiloplasty. The operations were performed on clinical base of The Oral Cavity Surgery and The Jaw-Facial Surgery Cathedra in Department of The Jaw-Facial Surgery of Clinical Medical Center (Baku). There was established, that application of uranostaphiloplasty procedure, as well as timely initiated rehabilitation, influences a further establishment of the patient personality. A timely refer to a speech therapeutist and the treatment began also have great significance for further establishment of the patient personality. Disorders of speech, incorrect bite hampers obtaining of education, working, interferes with a family creation, hampers the employment and worsens a quality of life.

Oral rehabilitation of patients with craniofacial disorders is a great challenge and needs a multidisciplinary approach. This is due to the diverse etiology of the disease and severity of changes in tissues and organs. Congenital absence of tooth germs manifested in the form of oligodontia or anodontia, the presence of persistent deciduous teeth in ectodermal dysplasia (ED), cleft lip and hard palate or cancer-induced changes in the tissues of the stomatognathic system are the most common causes of these disorders. The observed abnormalities are responsible for functional disorders of musculo-articular system, speech and chewing. In addition, noticeable adverse changes in the appearance have a huge psychological impact on patients and their well-being. Therefore, the treatment of these medical conditions should begin in childhood and comprise interdisciplinary rehabilitation, involving prosthetics and orthodontics supported by surgery, as well as speech or laryngological therapy. In this paper the interdisciplinary treatment of patients with oral hard and soft tissues disorders during ectodermal dysplasia is discussed. Early oral rehabilitation can restore lost or abnormally shaped tissues and proper functions of the masticatory system. It can also have a positive impact on further physical and psychological development of patients.

Introduction: Implant-borne rehabilitation in cleft lip and palate patient are aimed to allow for good orofacial functions, stable occlusion, and adequate support for the naso-labial region. The goal of our study was to evaluate the functional and esthetic results of the implant-born dental rehabilitation of the cleft lip and palate patients in our department., Material and Methods: Our retrospective study concerned patients operated between 1995 and 2010 in our department. All included patients suffered from a cleft alveolus and lip, with or without cleft palate. Dental implants were placed in the bone-grafted alveolus and the end of growth and at distance from the bone graft procedure. Criteria of implant survival and implant-borne rehabilitation success were defined., Results: A total of 78 implants were placed in 43 patients between 1995 and 2010. Two implants were lost (implant survival rate: 97.4%). Despite this loss, all the patients could be rehabilitated with good functional and esthetic results., Discussion: Implant-borne rehabilitation is a reliable solution for prosthetic rehabilitation in patients with cleft lip and palate. This solution allows for avoiding removable prosthesis and dental mutilation., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Objective: Evaluate the speech services using a Community-Based Speech Therapy model by trained speech assistants (SAs) on the improvement of articulation in cleft palate children., Material and Method: Seventeen children with repaired cleft palates who lived in Chiang Rai and Phayao provinces were registered to the camp. They received speech therapy with a 4-day intensive camp and five follow-up camps at Chiang Rai's The Young Men's Christian Association (YMCA). Eight speech assistants (SAs) were trained to correct articulation errors with specific modeling by the speech-language pathologists (SLPs). SAs encouraged family members to stimulate their children every day with speech exercise at home. Each camp was covered with a main speech therapy and others supported by the multidisciplinary team, as well as, discussion among SLPs, SAs and the care givers for feedback or difficulties., Results: Results showed a sufficient method for treating persistent speech disorders associated with cleft palate. Perceptual analyses presented significant improvement of misarticulation sounds both word and sentence levels after speech camp (mean difference = 1.5, 95% confidence interval = 0.5-2.5, p-value <0.01; mean difference = 2.5, 95% confidence interval = 1-3, p-value <0.001, respectively)., Conclusion: The Community-Based Speech Therapy model is a valid and efficient method for providing speech therapy in cleft palate children.

Background: Most children with cleft lip and palate have articulation problems because of compensatory articulation disorders from velopharyngeal insufficiency. Theoretically, children should receive speech therapy from a speech and language pathologist (SLP) 1-2 sessions per week. For developing countries, particularly Thailand, most of them cannot reach standard speech services because of limitation of speech services and SLP Networking of a Community-Based Speech Model might be an appropriate way to solve this problem., Objective: To study the effectiveness of a networking of Khon Kaen University (KKU) Community-Based Speech Model, Non Thong Tambon Health Promotion Hospital, Borabue, Maha Sarakham, in decreasing the number of articulation errors for children with CLP., Material and Method: Six children with cleft lip and palate (CLP) who lived in Borabue and the surrounding district, Maha Sarakham, and had medical records in Srinagarind Hospital. They were assessed for pre- and post-articulation errors and provided speech therapy by SLP via teaching on service for speech assistant (SA). Then, children with CLP received speech correction (SC) by SA based on assignment and caregivers practiced home program for a year., Results: Networking of Non Thong Tambon Health Promotion Hospital, Borabue, Maha Sarakham significantly reduce the number of post-articulation errors for 3 children with CLP. There were factors affecting the results in treatment of other children as follows: delayed speech and language development, hypernaslaity, and consistency of SC at local hospital and home., Conclusion: A networking of KKU Community-Based Speech Model, Non Thong Tambon Health Promotion Hospital, Borabue, and Maha Sarakham was a good way to enhance speech therapy in Thailand or other developing countries, where have limitation of speech services or lack of professionals.

Background: Cleft lip and palate (CLP) congenital anomalies have a high prevalence in the Northeast of Thailand. A care team's understand of treatment plan would help to guide the family of patients with CLP to achieve the treatment., Objective: To examine the impact of the empowering volunteer project, established in the northeast Thailand., Material and Method: The Empowering Volunteer project was conducted in 2008 under the Tawanchai Royal Granted project. The patients and family's general information, treatment, the group brainstorming, and satisfaction with the project were analysed., Results: Participants were 12 children with CLP their families and five volunteers with CLP; the participating patients were predominantly females and the mean age was 12.2 years. The treatment comprised of speech training, dental hygiene care, bone graft and orthodontic treatment. Four issues were addressed including: problems in taking care of breast feeding, instructions' needs for care at birth, difficulty in access information and society impact, and needs in having a network of volunteers., Conclusions: Empowering volunteer is important for holistic care of patients with CLP which provides easy access and multiple channels for patients and their families. It should be developed as part of the self-help and family support group, the development of community based team and comprehensive CLP care program.

Background: Prevalence of cleft lip and palate (CLP) is high in Northeast Thailand. Most children with CLP face many problems, particularly compensatory articulation disorders (CAD) beyond surgery while speech services and the number of speech and language pathologists (SLPs) are limited., Objective: To determine the effectiveness of networking of Khon Kaen University (KKU) Community-Based Speech Therapy Model: Kosumphisai Hospital, Kosumphisai District and Maha Sarakham Hospital, Mueang District, Maha Sarakham Province for reduction of the number of articulations errors for children with CLP., Material and Method: Eleven children with CLP were recruited in 3 1-year projects of KKU Community-Based Speech Therapy Model. Articulation tests were formally assessed by qualified language pathologists (SLPs) for baseline and post treatment outcomes. Teachings on services for speech assistants (SAs) were conducted by SLPs. Assigned speech correction (SC) was performed by SAs at home and at local hospitals. Caregivers also gave SC at home 3-4 days a week., Results: Networking of Community-Based Speech Therapy Model signficantly reduced the number of articulation errors for children with CLP in both word and sentence levels (mean difference = 6.91, 95% confidence interval = 4.15-9.67; mean difference = 5.36, 95% confidence interval = 2.99-7.73, respectively)., Conclusion: Networking by Kosumphisai and Maha Sarakham of KKU Community-Based Speech Therapy Model was a valid and efficient method for providing speech services for children with cleft palate and could be extended to any area in Thailand and other developing countries, where have similar contexts.

Introduction: The management of cleft lip, alveolar and palate sequelae remains problematic today. To optimize it, we tried to establish a new clinical index for diagnostic and prognostic purposes., Technical Note: Seven tissue indicators, that we consider to be important in the management of alveolar sequelae, are listed by assigning them individual scores. The final score, obtained by adding together the individual scores, can take a low, high or maximum value., Discussion: We propose a new classification (ACS: Alveolar Cleft Score) that guides the therapeutic team to a prognosis approach, in terms of the recommended surgical and prosthetic reconstruction, the type of medical care required, and the preventive and supportive therapy to establish. Current studies are often only based on a standard radiological evaluation of the alveolar bone height at the cleft site. However, the gingival, the osseous and the cellular areas bordering the alveolar cleft sequelae induce many clinical parameters, which should be reflected in the morphological diagnosis, to better direct the surgical indications and the future prosthetic requirements, and to best maintain successful long term aesthetic and functional results., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Rehabilitation of cleft patients is a process that occurs from birth to adult life and involves a team of many professionals. Reconstructive plastic surgery, despite its functional and aesthetic benefits to the patient, can restrict the normal anterior displacement that occurs in the growth of the maxilla, which, in turn, can lead to a concave profile that requires correction. This study aimed to demonstrate an alternative rehabilitation treatment for cleft patients who have severe maxillomandibular discrepancy and choose not to undergo orthognathic surgery. A retrospective review and case reports of rehabilitation treatment of cleft patients were performed, with an emphasis on prosthetic rehabilitation without orthognathic surgical procedures. Prosthetic rehabilitation is a fast and reversible option for cleft patients that provides facial harmony and facilitates the reintegration of these patients into society.

A 43-year-old woman with a unilateral cleft lip and palate, presenting a totally edentulous maxilla and mandible with marked maxillomandibular discrepancy, attended the Prosthodontics section of the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo for treatment. She could not close her mouth and was dissatisfied with her complete dentures. Treatment planning comprised placement of six implants in the maxilla, four in the mandible followed by prostheses installation and orthognathic surgery. The mandibular full arch prosthesis guided the occlusion for orthognathic positioning of the maxilla. The maxillary complete prosthesis was designed to assist the orthognathic surgery with a provisional prosthesis (no metal framework), allowing reverse treatment planning. Maxillary and mandibular realignment was performed. Three months later, a relapse in the position of the maxilla was observed, which was offset with a new maxillary prosthesis. This isa complex interdisciplinary treatment and two-year follow-up is presented and discussed. It should be considered that this type of treatment could also be applied in non-cleft patients.

Oral rehabilitation of adult patients with cleft lip and palate is related to the severity of the anatomical and functional alterations that hamper the proper closure of the nasopharynx. The ideal treatment is closure by bone graft and orthodontics. However, when surgery is not possible or when the patient does not wish to undergo surgery, a palatal prosthesis may offer the best solution in most clinical situations. The authors of this article propose a new classification to help the practitioner with decision making and prosthetic treatment planning for residual palatoalveolar cleft defects.

Recent advances in surgery and orthodontics have resulted in improvements in the management of patients with a cleft lip or palate. Early surgical intervention and bone-grafting procedures have frequently been used to ensure closure of the cleft and continuity of the alveolar bone. However, a need for the prosthodontic management of patients with a cleft palate still exists. Most frequently, the indication is to restore the edentulous spaces located anteriorly in the vicinity of the residual cleft defect. In addition to improving the esthetic outcome, prosthodontic management also is required to restore function, especially occlusion and speech. This clinical report illustrates the management of an adult patient with a unilateral cleft of the lip and palate who required prosthodontic rehabilitation after surgery. The patient had previously undergone multiple surgeries and did not want to consider implant therapy as a treatment option. Thus, the patient was managed with fixed and removable prosthodontics with a maxillary overdenture prosthesis retained by microextracoronal resilient attachments, which were laser welded onto crowns on abutment teeth to obtain a functionally and esthetically acceptable result., (Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Microsurgical nerve lengthening was performed in two siblings presenting a popliteal pterigium syndrome with a knee flexion contracture of 80 degrees. After the first attempt for nerve lengthening and knee extension elsewhere, a repeated lengthening was required due to continuing tip-toe walking and recurrent knee contracture at the age of 3 years. An extensive external and internal interfascicular microsurgical neurolysis resulted in a lengthening of the nerves. A full length of leg procedure had to be performed, inclusive of Achilles tendon lengthening to obtain a complete extension of the knee and a 90-degree ankle flexion. Maintaining the leg in a fully extended position was obtained with a dynamic splinting in the first month after the operation. When timing the operation we have to consider the importance of adequate precision of the microsurgical neurolysis, down to the identification of the Fontana bands, and the adequate postoperative splinting., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Background: Approximately 50% of children born with cleft palate present speech difficulties around 3 years of age, and several studies report on persisting phonological problems after palatal closure. However, studies on early phonology related to cleft palate are few and have so far mainly been carried out on English-speaking children. Studies on phonology related to cleft palate in languages other than English are also warranted., Aims: To assess phonology in Swedish-speaking children born with and without unilateral cleft lip and palate (UCLP) at 3 years of age, and to identify variables at 18 months that are associated with restricted phonology at age 3 years., Methods & Procedures: Eighteen consecutive children born with UCLP and 20 children without cleft lip and palate were included. Transcriptions of audio recordings at 18 months and 3 years were used. Per cent correct consonants adjusted for age (PCC-A), the number of established phonemes, and phonological simplification processes at 3 years were assessed and compared with different aspects of consonant inventory at 18 months., Outcomes & Results: PCC-A, the number of established phonemes, and the total number of phonological processes differed significantly at 3 years between the two groups. Total number of oral consonants, oral stops, dental/alveolar oral stops and number of different oral stops at 18 months correlated significantly with PCC-A at 3 years in the UCLP group., Conclusions & Implications: As a group, children born with UCLP displayed deviant phonology at 3 years compared with peers without cleft lip and palate. Measures of oral consonant and stop production at 18 months might be possible predictors for phonology at 3 years in children born with cleft palate., (© 2013 Royal College of Speech and Language Therapists.)

Purpose: To assess the effects of speech therapy on the acoustic characteristics of speech in a group of cleft lip and palate patients., Materials and Methods: In this experimental pilot study, eight patients with unilateral cleft lip and palate participated in the 13-month period of speech therapy. They had some exercises in the class and at home to reduce the hypernasality of speech. Using an acoustic software named Praat, three formants (F1, F2, F3) of speech sounds /b /, /p /, /f /, /v /, /k /, and /g / were obtained pre and post speech therapy. We used paired samples t-test to compare the acoustic variables of each consonant before and after the therapy., Results: No significant differences were found between the pre- and posttherapy acoustic measures for fricative consonants /f /, /v / and stop consonants /k / and /g/. However, a statistically significant improvement in hypernasality of labial consonants /b / and /p / was observed after the speech therapy., Conclusions: The present study underlines the role of a speech therapist in a complete cleft care team, in order to take care of the speech improvement of the patient and to motivate the parents to help the speech development of their child., (© 2013 Special Care Dentistry Association and Wiley Periodicals, Inc.)

Background: Newborns with cleft palate have a distorted maxillary arch at birth. Depending upon the type of cleft, infants suffer from a variety of problems, many of which are related to feeding difficulties. Feeding these babies is an immediate concern because there is evidence of delayed growth of children with cleft lip and palate (CLCP) compared to normal infants. Many methods have been devised to overcome these problems, including the use of special bottles, nipples, and initial obturator therapy., Review: A Pub Med search was conducted using the following search terms: feeding interventions in cleft lip and palate, feeding plate/obturator in cleft palate. All the relevant articles were studied and the reference list of selected articles was also studied. Effects of different feeding interventions in infants with cleft palate with special emphasis on obturators, based on descriptive reports, expert opinions, and available data from clinical trials was reviewed., Results: The combination of search terms generated a list of 74 articles out of which 51 articles were excluded based on analyses of abstracts and full texts. Three additional publications were identified by the manual search. A total of 26 relevant articles were selected which included randomised controlled trials and descriptive studies on feeding interventions and obturators., Conclusion: A single intervention may not fulfil all feeding requirements of infants with CLCP. Combined use of different feeding interventions such as palatal obturator, Haberman feeder, and breast milk pump and lactation education may successfully meet the feeding needs of both mother and child.

Objectives: This retrospective study assessed the dentoskeletal effect of late maxillary protraction (LMP; reverse-pull headgear, Class III elastics, and maxillary sutural loosening) in unilateral cleft lip and palate (UCLP) patients versus a control group of untreated UCLP patients., Materials and Methods: Cephalograms taken at age 13 to 14 years (T1) and 17 to 18 years (T2) were used for this study. The study group comprised 18 patients (10 male and 8 female, mean age at start of LMP therapy = 13.4 [0.45] years). A control groups of 17 patients (8 male and 9 female, mean age = 13.5 [0.44] years) was used for comparison., Results: The repeated-measures analysis of variance showed statistically significant changes across time between groups for the following variables (mean difference [T2-T1] in the study group, 95% confidence interval): SNA (°) (1.95, 0.75 to 3.15), A ⊥ Na Perp (mm) (1.82, 0.86 to 2.77), CoA (mm) (2.92, 1.53 to 4.31), ANB (°) (3.13, 2.02 to 4.24), Wits (mm) (7.82, 5.01 to 10.54), Mx-Md Diff (mm) (0.62, -1.58 to 2.83), Occl P-SN (°) (-3.98, -5.99 to -1.98), overjet (mm) (8.82, 5.90 to 11.74), FMIA (°) (4.05, -0.05 to 8.15), and IMPA (°) (-5.77, -9.74 to -1.80). Late maxillary protraction created a slight open bite (0.66 mm). Trends for overeruption of mandibular incisors and an increase in lower face height (P = .07 for both) were noted in the study group., Conclusions: Late maxillary protraction produced a combination of skeletal changes (protraction of maxilla, improvement in the maxillo-mandibular skeletal relationship) and dental compensations (counterclockwise rotation of occlusal plane, retroclination of mandibular incisors) in patients with UCLP. Late maxillary protraction was also associated with some unwanted tooth movements (open bite tendency, mandibular incisors overeruption).

Esthetic evaluation of cleft lip and palate rehabilitation outcomes may assist in the determination of new surgical interventions and aid in reevaluation of treatment protocols. Our objective was to compare esthetics assessments of the nasolabial region in children with a unilateral cleft lip and palate between healthcare professionals who were experienced in the treatment of cleft lip and palate and those who were inexperienced. The study group included 55 patients between 6 and 12 years of age who had already undergone primary reconstructive surgery for unilateral cleft lip. Standardized digital photographs were obtained, and the esthetic features of the nose, lip, and nasolabial region were evaluated. We used only cropped photographic images in the assessments of healthcare professionals with and without experience in cleft lip and palate. Interrater analysis revealed highly reliable assessments made by both the experienced and inexperienced professionals. There was no statistically significant difference in the esthetic attractiveness of the lip and nose between the experienced and inexperienced professionals. Compared with the inexperienced professionals, the experienced professional evaluators showed higher satisfaction with the esthetic appearance of the nasolabial region; however, no difference was observed in the analysis of the lip or nose alone.

Background: Abnormal facial growth is a well-known sequelae of cleft lip and palate (CLP) resulting in maxillary retrusion and a class III malocclusion. In 10-50% of cases, surgical correction involving advancement of the maxilla typically by osteotomy methods is required and normally undertaken in adolescence when facial growth is complete. Current evidence for the impact of the surgery on velopharyngeal function is weak and mixed., Aims: The first objective of the study was to investigate the nature of the effect of maxillary osteotomy on the perceptual outcomes of velopharyngeal function in CLP. The second objective was to establish if speech changes seen early at 3 months post-operation persisted for a year after/following surgery', when it is considered that the maxilla is relatively stable., Methods & Procedures: Twenty consecutive patients with CLP undergoing maxillary osteotomy by a single surgeon were seen pre-operatively (T1), 3 months (T2) and 12 months (T3) post-operation. A non-cleft control group (NonCLP) undergoing surgery was also recruited. Speech data were collected using the Cleft Audit Protocol for Speech-Augmented (CAPS-A). A velopharyngeal composite score-summary (VPC-SUM) was derived from specific CAPS-A-rated parameters. An external CAPS-A-trained therapist, blinded to the study, rated the randomized samples and inter-rater reliability was established., Outcomes & Results: For the CLP group, hypernasality and nasal turbulence increased significantly post-operation. Planned comparisons were significant for T1-T2 only with a medium effect size. For hypernasality, the CLP group differed statistically from the NonCLP group at T2 and T3. For nasal turbulence, the CLP group differed statistically from the NonCLP group at T2. For VPC-SUM, there were statistically significant changes post-operatively between T1-T2 and T1-T3 only with medium effect sizes for the CLP group only., Conclusions & Implications: This study provides evidence that maxillary osteotomy affects patients with and without CLP differently. In patients with CLP, surgery may impact negatively on velopharyngeal function for speech and changes seen early on at 3 months post-operatively appear to persist at 12 months postoperatively. The findings in this study have implications for the speech care pathway of patients with CLP undergoing maxillary osteotomy in terms of assessment, review and management., (© 2013 Royal College of Speech and Language Therapists.)

Background: Cleft lip and cleft palate are the most common craniofacial anomalies affecting approximately 2.49 of every 1,000 children born in North-east of Thailand. Srinagarind Hospital has 100-150 cases of cleft lip each year. Children with cleft lip and palate need surgical procedures as soon as possible. After lip repair the normal recommendation is not using bottle or breast feeding for 2 weeks to avoid tension at the sutured area during sucking and possible cause of wound dehiscence. So this is quite complicated for the parents, and patients feel frustrated, cry, and move their head around, because of hunger which cannot easily be satisfied. Previous research found that sucking does not cause wound dehiscence, but mentioned no detail about severity of cleft., Objective: Primary objective is to compare surgical wound dehiscence between breast feeding/bottle and spoon/syringe feeding after lip repair., Material and Method: This is an experimental study: non-inferiority trials study. The population is the patients with cleft lip who underwent lip repair in Inpatient Department 3C, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. The study period is during May 2010-February 2013. The total sample size in the present study is 192 participants, 96 cases breast/bottle feeding, 96 cases spoon/syringe feeding. The wound dehiscence rate was analyzed by Z-test. Parents'satisfaction is a qualitative data and was analyzed through content analysis., Results: No statistical significant diference between breast/bottle and spoon/syringe groups (p-value = 0.320, 95% confidence interval -0.031-0.010). Parents were more satisfied to feed children by breast/bottle and patients were more relaxed with breast/bottle feeding., Conclusion: Breast/bottle feeding and syringe/spoon feeding have the same result on the surgical wound. Breast/bottle feeding are not causes of wound dehiscence.

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.

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.

This paper presents the treatment protocol of maxillofacial surgery in the rehabilitation process of cleft lip and palate patients adopted at HRAC-USP. Maxillofacial surgeons are responsible for the accomplishment of two main procedures, alveolar bone graft surgery and orthognathic surgery. The primary objective of alveolar bone graft is to provide bone tissue for the cleft site and then allow orthodontic movements for the establishment of an an adequate occlusion. When performed before the eruption of the maxillary permanent canine, it presents high rates of success. Orthognathic surgery aims at correcting maxillomandibular discrepancies, especially anteroposterior maxillary deficiencies, commonly observed in cleft lip and palate patients, for the achievement of a functional occlusion combined with a balanced face.

Objective: To determine the difference in the effects of facemask with miniplate (FM-MP) anchorage on maxillary protraction in growing cleft patients between unilateral (UCLP) and bilateral cleft lip and palate (BCLP) groups., Materials and Methods: The samples consisted of a UCLP group (N  =  15, 13 boys and 2 girls; mean age 10.98 years; mean protraction duration 2.37 years) and a BCLP group (N  =  15, all boys; mean age 11.42 years; mean protraction duration 2.36 years), who were treated with the same surgical technique (rotation and advancement flap and double opposing Z-plasty) by one surgeon and with FM-MP by one orthodontist. Lateral cephalograms were taken before (T1) and after FM-MP (T2). Fourteen skeletal and dental variables were measured. Independent and paired t-tests were performed for statistical analysis., Results: There were no differences in mean age and values of variables at the T1 stage and in the duration of protraction between the two groups. The BCLP group showed less advancement of point A than the UCLP group (ΔA-vertical reference plane, 2.51 mm vs 4.06 mm, P < .05; ΔA-N perpendicular, 0.79 mm vs 2.26 mm, P < .05; ΔSNA, 0.45° vs 2.85°, P < .01). Since counterclockwise rotation of the palatal plane in two groups was minimal (-0.36° vs -0.87°), no difference was observed with regard to clockwise rotation of the mandible (0.46° vs -0.07°). There were no differences in the degree of labioversion of the maxillary incisor (8.16° vs 7.10°), linguoversion of the mandibular incisor (-2.66° vs -2.14°), and increase in overjet (5.39 mm vs 5.70 mm) between the two groups., Conclusion: In FM-MP therapy of growing cleft patients under the conditions of this study, the UCLP group shows a more favorable change in maxillary advancement than the BCLP group.

Providing long-term multidisciplinary care for cleft lip/palate is a challenge for international humanitarian organizations that perform surgery across borders. The use of telemedicine as a means of evaluating speech in patients with cleft lip/palate has not been studied previously. We looked at determining whether a speech evaluation performed by a speech-language pathologist (SLP) using telemedicine would be equivalent to a speech evaluation performed in-person, in an international setting between Tijuana, Mexico and San Diego, CA. Spanish-speaking SLPs developed an informal protocol to evaluate several speech characteristics. Patients were simultaneously evaluated by 2 SLPs, one in-person in Tijuana and the other over telemedicine videoconference from San Diego, CA. In addition, we obtained data regarding the parents experience with telemedicine through a satisfaction survey. Results showed no statistically significant differences between the 2 methods of speech evaluation, particularly in oral muscle tone, resonance, lingual lateralization, oral pressure, and dentition. The satisfaction survey showed family satisfaction with the speech evaluation performed using telemedicine. Thus, telemedicine represents an effective medium for conducting speech assessment in patients with cleft lip/palate, allowing for increased access to care for underserved populations.

Objective: To assess the effect of orthodontic treatment on Goslon Yardstick outcome., Design: Retrospective study., Patients: A series of 66 consecutive patients born with a complete unilateral left lip and palate. Patients were sorted into a nontreatment group (n  =  47) and a treatment group (n  =  19)., Method: Three assessors trained in the use of the Goslon Yardstick ranked the dental arch relationships of study casts taken at 6 and 9 years., Results: There was only a fair agreement (κ  =  .33) between 6- and 9-year Goslon Yardstick scores for the cohort of 66 patients, with a significant (p < .05) difference in the mean score at 6 years (3.17 ± 0.8) and at 9 years (2.88 ± 1.0). Removal of 19 subjects who had orthodontic inventions prior to taking of the 9-year-old study cast improved the agreement to moderate (κ  =  .52). There was no significant difference (p > .05) in mean scores at 6 and 9 years (3.13 ± 0.9 and 3.17 ± 1.03, respectively). The treatment group exhibited significant differences (p < .001) with mean Goslon Yardstick scores of 3.0 ± 0.9 at 6 and 2.25 ± 0.45 at 9 years., Conclusions: The inclusion of patients who had received orthodontic treatment prior to taking of study casts being used for Goslon Yardstick scoring can result in a more favorable outcome. Patients who have received active orthodontic treatment prior to taking of dental casts should be excluded or accounted for in audits to assess primary cleft surgical outcome in patients with a unilateral cleft lip and palate.

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.

Cleft lip and palate is the most common among craniofacial malformations and causes several esthetic and functional implications that require rehabilitation. This paper aims to generally describe the several aspects related to this complex pathology and the treatment protocol used by the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC-USP) along 40 years of experience in the treatment of individuals with cleft lip and palate.

The incidence of cleft lip and/or palate (CLP) in Kirov region is 1:1078 newborns. More than half of the patients (52%) have both cleft lip and palate thus requiring more complex and time consuming treatment. Multidisciplinary approach to CLP patients rehabilitation used in tertiary care center is described in the study.