Cleft Palate Craniofac. J. [JOURNAL]
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200 papers
Enhanced Efficacy of Combined Iliac Crest Bone Graft and Recombinant Human Bone Morphogenetic Protein for Alveolar Bone Grafting.
Manasyan A, Roohani I, Kreh C … +8 more , Kim A, Guler M, Firriolo J, Herrera L, Turk M, Magee WP, Urata MM, Hammoudeh JA
Cleft Palate Craniofac J · 2026 Jun · PMID 42318690 · Publisher ↗
BackgroundThis study compares clinical and radiographic outcomes in alveolar bone grafting (ABG) using iliac crest bone graft (ICBG) alone, demineralized bone matrix (DBM) with recombinant human bone morphogenetic protei...
BackgroundThis study compares clinical and radiographic outcomes in alveolar bone grafting (ABG) using iliac crest bone graft (ICBG) alone, demineralized bone matrix (DBM) with recombinant human bone morphogenetic protein-2 (rhBMP-2), and ICBG with recombinant human bone morphogenetic protein-2 with demineralized bone matrix (rhBMP2/DBM).PurposeWe evaluated differences in clinical success and radiographic bone formation among grafting techniques for secondary alveolar cleft repair.Study Design, Setting, and SampleRetrospective cohort study of patients undergoing secondary ABG for cleft alveolus between 2017 and 2023 at a tertiary children's hospital.Independent VariableType of grafting technique: ICBG alone, DBM with rhBMP-2, or ICBG with rhBMP-2.Main Outcome VariablesThe primary outcome was radiographic success (bony bridging on cone-beam computed tomography). Secondary outcomes included vertical bone height and reoperation.CovariatesAge, sex, cleft laterality, and graft type.AnalysesDescriptive statistics and comparative analyses were performed. Statistical significance was set at < .05.ResultsA total of 432 patients (527 clefts) were included: 196 ICBG, 284 DBM + rhBMP-2, and 47 ICBG + rhBMP-2. Radiographic success was highest in the ICBG + rhBMP-2 group (89.4%) compared with ICBG (65.3%; = .001) and DBM + rhBMP-2 (61.6%; < .001). Mean vertical bone height was greater in the ICBG + rhBMP-2 group (7.4 ± 2.6 mm) versus ICBG (4.7 ± 1.9 mm; < .001) and DBM + rhBMP-2 (4.4 ± 1.2 mm; < .001).Conclusions and RelevanceICBG combined with rhBMP-2 demonstrates improved radiographic bone formation and vertical height compared with alternative grafting strategies, without increasing reoperation rates.
Implantation of Infant Platelet-Rich Plasma/Fibrin with Gingivoperiosteoplasty in Patients with Unilateral Cleft Lip and Alveolus.
Kobayashi S, Yabuki Y, Sugiyama M … +2 more , Fukui A, Hirakawa T
Cleft Palate Craniofac J · 2026 Jun · PMID 42318688 · Publisher ↗
ObjectiveNo studies have examined the effectiveness of platelet-rich plasma (PRP) alone and platelet-rich fibrin (PRF) without alveolar bone grafting or other bone substitutes for alveolar cleft repair during infancy. Th...
ObjectiveNo studies have examined the effectiveness of platelet-rich plasma (PRP) alone and platelet-rich fibrin (PRF) without alveolar bone grafting or other bone substitutes for alveolar cleft repair during infancy. This study evaluated the effectiveness of autologous PRP/PRF on alveolar regeneration in infantile unilateral cleft lip and alveolus.DesignRetrospective study.SettingPatients, Participants: A total of 56 patients with alveolar clefts were classified into the no PRP/PRF (which received gingivoperiosteoplasty [GPP] without PRP/PRF), PRP (which received GPP with PRP), and PRF (which received GPP with PRF) groups.InterventionsRegarding preparation, 5 mL of blood was withdrawn, and 1 mL each of PRP and PRF was prepared via centrifugal separation. PRP was implanted in the alveolar cleft after loading it into a commercially available gelatin sponge, while PRF was implanted directly.Main Outcome MeasuresPostoperative bone formation was assessed using computed tomography and radiography for qualitative analysis.ResultsThe new alveolar bone volume was higher in the PRF group than in the other groups; however, no differences were observed between the PRP, PRF, and control groups.ConclusionThis study was performed without complication. However, no significant difference in bone formation was found between the PRP, PRF, and control groups.
Atypical Nasopalatine Duct Cyst in a Grafted Alveolar Cleft: Radiographic Diagnostic Challenges.
Carneiro Cardoso AC, Galhardo TDC, Dias TDN … +5 more , De Carvalho IMM, Bullen IRFR, Lara VS, Faco RAS, Pagin O
Cleft Palate Craniofac J · 2026 Jun · PMID 42312435 · Publisher ↗
Nasopalatine duct cysts may present with atypical radiographic features when arising in grafted alveolar cleft regions. A patient with cleft lip and palate presented with a well-defined radiolucent lesion in the anterior...
Nasopalatine duct cysts may present with atypical radiographic features when arising in grafted alveolar cleft regions. A patient with cleft lip and palate presented with a well-defined radiolucent lesion in the anterior maxilla following alveolar bone grafting. Imaging demonstrated a unilocular lesion associated with displacement of the incisive canal, mimicking other odontogenic and nonodontogenic cysts. The unusual location and surgical history posed diagnostic challenges. Local trauma related to grafting may have contributed to cyst development. Careful radiographic assessment is essential for accurate differential diagnosis and appropriate management.
Prevalence of Ectopic Maxillary Third Molars Inferior to Second Molars in Patients with Cleft Lip and Palate: Retrospective Study.
Ren T, Yang R, Xun H … +4 more , Heron M, Stole C, Stanco L, Zinn IM
Cleft Palate Craniofac J · 2026 Jun · PMID 42312427 · Publisher ↗
ObjectiveTo determine the prevalence of maxillary third molars developing inferior to the second molars in patients with cleft lip and palate (CLP) and to describe associated clinical and radiographic characteristics.Des...
ObjectiveTo determine the prevalence of maxillary third molars developing inferior to the second molars in patients with cleft lip and palate (CLP) and to describe associated clinical and radiographic characteristics.DesignThis retrospective chart review assessed maxillary third molar position using cone-beam computed tomography (CBCT).SettingTertiary cleft and craniofacial center within an academic institution.Patients/ParticipantsPatients aged ≥7 years with CLP who underwent CBCT imaging between 2019 and 2025. A total of 104 patients met inclusion criteria (79 unilateral cleft lip and palate (UCLP), 25 bilateral cleft lip and palate (BCLP)).InterventionsNo experimental interventions were performed.Main Outcome Measure(s)Prevalence of maxillary third molars positioned inferior to the second molars, defined radiographically by crown position relative to the adjacent second molar. Secondary measures included developmental stage, visibility on 2-dimensional (2D) versus 3-dimensional (3D) imaging, and associated second molar eruption disturbances.ResultsEctopic third molars were identified in 4 of 104 patients (3.8%), occurring in 3 UCLP and 1 BCLP patient. All ectopic teeth were in early developmental stages (Demirjian A-C), were poorly visible on 2D panoramic reconstructions, and were associated with delayed or failed eruption of the second molar.ConclusionsInferior positioning of maxillary third molars is an uncommon but clinically significant eruption disturbance in CLP. When CBCT imaging is obtained for clinical indications in patients with CLP, careful 3D assessment of third molar position may facilitate early identification of ectopic development and help prevent second molar impaction. Further study is needed to optimize timing and indications for early surgical removal.
Comparative Outcomes and Morphology Following Surgical Reconstruction for Mercedes Benz Craniosynostosis.
Harrison LM, Hallac RR, Kane AA … +1 more , Sanati-Mehrizy P
Cleft Palate Craniofac J · 2026 Jun · PMID 42312353 · Publisher ↗
ObjectiveMercedes Benz craniosynostosis is a multisutural pattern characterized by posterior vault constriction due to fusion of sagittal and bilateral lambdoid sutures. Middle-posterior cranial vault remodeling (MPCVR)...
ObjectiveMercedes Benz craniosynostosis is a multisutural pattern characterized by posterior vault constriction due to fusion of sagittal and bilateral lambdoid sutures. Middle-posterior cranial vault remodeling (MPCVR) and posterior cranial vault distraction osteogenesis (PCVDO) are commonly used to address posterior vault deficiency, but comparative data in this population remain limited. This study evaluates perioperative, volumetric, and craniometric outcomes following MPCVR and PCVDO in Mercedes Benz craniosynostosis.DesignA retrospective review of computed tomographic images before and 1 year after surgery.SettingTertiary pediatric institution.Patients, ParticipantsEighteen patients with Mercedes Benz craniosynostosis.InterventionsMPCVR or PCVDO.Main Outcome Measure(s)Demographics, operative characteristics, and craniometric measurements.ResultsEighteen patients were included; 50% underwent MPCVR, 27.8% PCVDO, and 22.2% strip craniectomy. PCVDO demonstrated a significantly shorter operative time than MPCVR ( = .008) and trended toward lower blood loss. MPCVR produced a 50.8% increase in total intracranial volume, with the greatest expansion in the posterior vault (60.6%). PCVDO resulted in a 28.6% total volume increase, with posterior expansion (21.5%). Craniometric outcomes showed MPCVR achieved larger gains in width (20.4%), middle height (19.3%), and posterior height (14.7%), whereas PCVDO produced greater increases in circumference (11.22%), cranial length (15.28%), and vertex angle (18.99%). Both procedures improved skull base angles, with larger reductions observed in the PCVDO group.ConclusionsMPCVR and PCVDO exhibit distinct expansion patterns in Mercedes Benz craniosynostosis. MPCVR offers broad volumetric remodeling, while PCVDO provides greater longitudinal expansion. These findings support individualized selection of posterior vault techniques for this rare craniosynostosis subtype.
A Case of -Related Early Onset Marfan Syndrome with Multi-Suture Craniosynostosis.
Godfrey AS, Garza D, Schweitzer D … +1 more , Thang CK
Cleft Palate Craniofac J · 2026 Jun · PMID 42312335 · Publisher ↗
Early-onset Marfan Syndrome (eoMFS) is caused by pathogenic variants in the fibrillin-1 () gene. Typical clinical findings include a prematurely aged appearance, severe atrioventricular valve dysfunction (mitral/tricuspi...
Early-onset Marfan Syndrome (eoMFS) is caused by pathogenic variants in the fibrillin-1 () gene. Typical clinical findings include a prematurely aged appearance, severe atrioventricular valve dysfunction (mitral/tricuspid valve insufficiency), and skeletal findings-primarily arachnodactyly, multiple joint contractures, and pectus deformity. Craniosynostosis has been reported in rare cases of eoMFS, but not in association with the c.3037G>A, variant in . Here we present a case of a 2-month-old male with bilateral lambdoidal and sagittal craniosynostosis diagnosed with eoMFS after genome sequencing identified a pathogenic variant in c.3037G>A,
Layered Reconstruction of Full-Thickness Alar Deficiency in Tessier 1 Nasal Clefts: A 2-Case Technical Note.
Allam K
Cleft Palate Craniofac J · 2026 Jun · PMID 42300691 · Publisher ↗
ObjectiveTo describe a layered reconstructive technique for full-thickness alar deficiency in unilateral Tessier 1 nasal clefts.DesignTechnical note illustrated by a 2-case series with medium-term follow-up.SettingSingle...
ObjectiveTo describe a layered reconstructive technique for full-thickness alar deficiency in unilateral Tessier 1 nasal clefts.DesignTechnical note illustrated by a 2-case series with medium-term follow-up.SettingSingle tertiary academic plastic and craniofacial surgery center.Patients, ParticipantsTwo pediatric patients aged 2 and 4 years with unilateral Tessier 1 alar clefts demonstrating full-thickness deficiency of lining, structural support, and external cover.InterventionsLayered reconstruction using a hinged cutaneous lining flap, auricular cartilage graft support, and dorsal nasal transposition flap for external cover.Main Outcome Measure(s)Clinical contour stability, nostril patency, scar quality, need for revision, and caregiver-reported satisfaction.ResultsAt 3 and 3.5 years follow-up, both patients demonstrated stable alar contour, maintained nostril patency, no collapse or notching, and no secondary revisions.ConclusionsThe described layered technique provides a feasible reconstructive option for selected Tessier 1 alar clefts with full-thickness deficiency and demonstrated encouraging medium-term stability.
The Negative Impact of External Activation Ports on Cranial Distraction: Systematic Review of the Literature and Proportional Meta-Analysis.
Fouda MA, Dostal D, Hoffman CE
Cleft Palate Craniofac J · 2026 Jun · PMID 42300685 · Publisher ↗
ObjectivesWe aimed to quantify the prevalence of perioperative complications attributable to external activation ports in pediatric posterior cranial vault distraction osteogenesis (PCVDO) and to evaluate the influence o...
ObjectivesWe aimed to quantify the prevalence of perioperative complications attributable to external activation ports in pediatric posterior cranial vault distraction osteogenesis (PCVDO) and to evaluate the influence of distraction protocol parameters on complication risk.MethodsFollowing PRISMA 2020 guidelines, six databases (2009-2025) were searched for studies reporting complications in children (<18 years) undergoing PCVDO.ResultsAcross 25 eligible studies, 154 adverse events were reported, yielding a pooled overall complication rate of 28.1%. Wound infection was most common (13.7%), followed by broken external activation ports (4.5%) and loosened footplates (3.1%). Mechanical failures accounted for 35.7% of all adverse events and frequently necessitated unplanned surgical intervention: 40% required intraoperative adjustment or premature removal of the distraction system. Each additional day of active distraction increased the risk of footplate loosening by 17%, while each additional day of consolidation increased the risk of breakage of the external activation ports by 1%, indicating cumulative mechanical stress on the distraction. External activation ports were associated with an elevated risk of wound infection, mechanical failure, and unplanned return to the operating room in pediatric PCVDO. The mechanical analyses demonstrated that off-axis loading, torque transmission through skin exits, and cumulative cyclic forces during prolonged distraction and consolidation phases could negatively impact device stability and vector fidelity.ConclusionsThese findings highlight the inherent mechanical limitations of externalized subcutaneous craniofacial distraction systems and underscore the need for next-generation, fully internalized, external port-free distraction technologies that optimize biomechanical alignment, reduce soft-tissue morbidity, and enhance clinical reliability.
Surgeon's-View Camera for Intraoral and Deep Craniofacial Surgery: A Refined Technique for Enhanced Visualization.
Seo D, Ishii H, Kikuchi A … +5 more , Miura T, Sasaki Y, Funayama E, Tamada I, Watanabe A
Cleft Palate Craniofac J · 2026 Jun · PMID 42295003 · Publisher ↗
ObjectiveTo refine and adapt an existing surgeon's-view camera technique for application in intraoral and deep craniofacial surgical fields, providing a lightweight, low-cost, and educationally valuable visualization met...
ObjectiveTo refine and adapt an existing surgeon's-view camera technique for application in intraoral and deep craniofacial surgical fields, providing a lightweight, low-cost, and educationally valuable visualization method.DesignA technical innovation study evaluating a customized mounting and imaging system for surgeon's-view video recording in craniofacial surgery.Patients/ParticipantsRepresentative craniofacial cases were recorded, including palatoplasty and pharyngeal flap surgery.InterventionsA USB camera (IMX179 sensor, M12 mount) was mounted directly onto surgical loupes or a head-mount using a custom 3D-printed housing. The system incorporated an aperture-narrowing disc to increase the depth of field and utilized a smartphone as the recording and power source.ResultsThe system successfully recorded clear, stable, surgeon-aligned videos of deep surgical fields without additional recording equipment. The aperture modification improved focus stability, though image brightness and sharpness were reduced. Lens interchangeability and smartphone mirroring enabled flexible field-of-view adjustment and real-time sharing with surgical staff.ConclusionsThis refined surgeon's-view camera system is a practical, adaptable, and affordable solution for recording deep craniofacial procedures. Despite minor image trade-offs, it enhances surgical education and may broaden accessibility to high-quality operative video recording.
Cross-Sectional and Longitudinal Psychosocial Risk Assessment in Families of Children With Craniofacial Conditions: A Retrospective Chart Review Study.
Udaipuria S, Umbaugh H, Baylis AL … +7 more , Kirschner RE, Pearson GD, Rabkin AN, Grover A, Thompson A, Smith A, Crerand CE
Cleft Palate Craniofac J · 2026 Jun · PMID 42294984 · Publisher ↗
ObjectiveTo examine relationships between Psychosocial Assessment Tool-Craniofacial Version (PAT-CV) scores and patient demographic and clinical characteristics; to evaluate changes in PAT-CV scores over time.DesignRetro...
ObjectiveTo examine relationships between Psychosocial Assessment Tool-Craniofacial Version (PAT-CV) scores and patient demographic and clinical characteristics; to evaluate changes in PAT-CV scores over time.DesignRetrospective chart review.SettingUS pediatric academic medical center.ParticipantsCaregivers of 1323 children (mean age 6.78 ± 4.87 years, 54% male) with craniofacial conditions presenting for a team visit; 414 children had 2 consecutive visits, an average of 1.1 years apart.Main Outcome MeasuresPAT-CV scores.ResultsCross-sectionally, higher PAT-CV total scores were associated with older child age, public insurance, craniofacial conditions other than cleft, and other chronic conditions (all < .05). PAT-CV total scores were stable, with no significant differences for total scores and risk classification categories over about a year.ConclusionsDemographic and clinical characteristics were significantly related to PAT-CV scores at baseline, and scores were stable over a 1-year period. Craniofacial psychosocial screening can be informed by identified risk factors within universal screening.
Mirror-image Bilateral Complete and Incomplete Cleft Lip and Alveolus in Monozygotic Twins: A Case Report.
Köppert S, Metz P, Hanken H
Cleft Palate Craniofac J · 2026 Jun · PMID 42294980 · Publisher ↗
Cleft lip and/or palate (CL/P) represent one of the most common congenital malformations in the oral and maxillofacial region, and various factors are associated with the development of CL/P and its subtypes. Despite an...
Cleft lip and/or palate (CL/P) represent one of the most common congenital malformations in the oral and maxillofacial region, and various factors are associated with the development of CL/P and its subtypes. Despite an increased concordance rate in monozygotic twins, mirror-image cleft formations represent a very rare phenotype, for which only very few case reports exist in the literature. The present case report describes a female pair of monozygotic twins from Germany who were born with mirror-image bilateral complete and incomplete cleft lip and alveolus.
Hospital Admissions for Cleft Lip and Palate in Brazil (2008-2024): Temporal Trends, Racial Disparities, and Regional Efficiency Clusters.
Cerqueira Da Silva LK, Martins GK
Cleft Palate Craniofac J · 2026 Jun · PMID 42294978 · Publisher ↗
ObjectiveTo describe temporal trends in hospital admissions for cleft lip and/or palate (CL/P) repair in Brazil, assess the COVID-19 pandemic impact, examine racial and demographic disparities in length of hospital stay...
ObjectiveTo describe temporal trends in hospital admissions for cleft lip and/or palate (CL/P) repair in Brazil, assess the COVID-19 pandemic impact, examine racial and demographic disparities in length of hospital stay (LOS), and identify regional efficiency patterns.DesignRetrospective ecological study using nationwide hospital admission data.SettingBrazilian Unified Health System (SUS), covering public sector inpatient procedures. Participants: 98,998 hospital admissions for CL/P surgical repair from 2008 to 2024.InterventionsNone (observational analysis of primary/secondary surgical repairs). Main Outcome Measures: Annual admission volumes and trends (annual percent change via Prais-Winsten regression); LOS by race/color (Kruskal-Wallis test); state-level clustering (K-means) based on volume, sex distribution, and mean LOS.ResultsMale predominance (ratio 1.36:1); 70% repairs under age 5. Stable volumes until 33% decline in 2020, with incomplete recovery. Significant racial disparities in LOS ( = .0007), longer among Brown (Parda) and Indigenous children. Heterogeneous state trends; four clusters identified, with São Paulo high-volume/moderate-stay vs. northern low-volume/prolonged-stay.ConclusionsBrazil has robust CL/P surgical capacity, but racial and profound regional disparities persist, compromising equity and efficiency. Targeted investment in northern regions, decentralized expertise, and standardized protocols are needed to reduce inequities.
An Analysis of Predictors of Early Morbidity and Mortality in Infants with Robin Sequence.
Lisk RC, Perez Rivera LR, Kantar RS … +1 more , Flores RL
Cleft Palate Craniofac J · 2026 Jun · PMID 42294976 · Publisher ↗
ObjectiveTo assess the incidence of Robin Sequence in the United States and evaluate predictors of early morbidity and mortality.DesignRetrospective cohort study.SettingEpic Cosmos database.Patients, ParticipantsPatients...
ObjectiveTo assess the incidence of Robin Sequence in the United States and evaluate predictors of early morbidity and mortality.DesignRetrospective cohort study.SettingEpic Cosmos database.Patients, ParticipantsPatients with Robin Sequence diagnosed within the first year of life from January 2015 to December 2024.InterventionsVariables including prenatal drug exposure (PDE), prematurity, intrauterine growth restriction (IUGR), concomitant airway diagnoses, genetic syndromes, and anomalies of the cardiopulmonary, gastrointestinal, or central nervous system (CNS) were captured.Main Outcome Measure(s)Incidence across a 10-year period and associations with admission to the neonatal intensive care unit (NICU) and length of stay (LOS), 30-day readmission and ED visit, and one-year mortality through a multivariate logistic regression.Results3863 patients were identified, for an incidence of 1 in 3713 live births. NICU admission was significantly associated with PDE, prematurity, IUGR, tracheomalacia, laryngomalacia, cleft palate, and presence of a cardiopulmonary or CNS anomaly. NICU LOS was associated with prematurity, bronchomalacia, and the presence of a gastrointestinal anomaly. 30-day readmission was associated with PDE, prematurity, tracheomalacia, laryngomalacia, cleft palate, cardiopulmonary anomalies, and CNS anomalies. 30-day ED visit was associated with prematurity, tracheomalacia, cleft palate, cardiopulmonary anomalies, and CNS anomalies. One-year mortality was associated with prematurity, IUGR, cardiopulmonary anomalies, and CNS anomalies.ConclusionsSignificant associations were identified between morbidity and mortality and perinatal factors, concomitant airway diagnoses, and the presence of cardiopulmonary and CNS anomalies. These findings underscore the importance of an early comprehensive evaluation for patients with Robin Sequence.
Evaluating the Respiratory Muscle Function in Patients with Cleft Lip and Palate: Maximal Inspiratory and Expiratory Pressure Analysis.
Venkatasamy NS, Ayub II, Kailasam V … +1 more , Subramanian CS
Cleft Palate Craniofac J · 2026 Jun · PMID 42294975 · Publisher ↗
ObjectiveTo evaluate the respiratory muscle strength in patients with cleft lip and palate (CLP) and correlate with airway dimensions.DesignCross-sectional.SettingThe study was conducted at a Sri Ramachandra Dental Colle...
ObjectiveTo evaluate the respiratory muscle strength in patients with cleft lip and palate (CLP) and correlate with airway dimensions.DesignCross-sectional.SettingThe study was conducted at a Sri Ramachandra Dental College and hospital in India.ParticipantsAdult patients were divided into three groups with eleven participants in each group. Group 1 comprised patients with CLP who had undergone alveolar bone grafting (ABG) but without maxillary expansion. Group 2 comprised patients with CLP, who had undergone ABG and maxillary expansion. Group 3 patients formed the control group which comprised non-CLP, Class I skeletal base patients.Main OutcomeSpirometric tests were performed, and maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured.ResultsMean MIP values for group 1, group 2, and group 3 were 2.5 ± 1.2 kPa, 5.6 ± 1.9 kPa, and 6.0 ± 1.9 kPa while MEP values were 4.1 ± 1.4 kPa, 6.2 ± 1.4 kPa, and 6.6 ± 1.9 kPa, respectively. Patients who had undergone ABG, but not maxillary expansion (Group 1) had statistically significant lesser MIP and MEP values ( <.001*). The mean peak expiratory flow and forced expiratory volume (FEV1) values were also decreased in group 1 but were not statistically significant ( >.05). Pharyngeal volume also decreased in patients with CLP. ( <.05). A positive, statistically significant correlation was found between nasopharyngeal volume (NPV) and MIP (R = 0.53) and NPV and MEP (R = 0.44) ( <.05*).ConclusionThis research provides conclusive evidence that patients with CLP have respiratory muscle weakness. This may result in functional deficits. The interdisciplinary team should plan the treatment accordingly.
Laterality and Sidedness in Orofacial Clefts: Definitions and a Framework for Future Research.
Chong DK, Fell MJ, Butterworth S … +7 more , Lewis S, Fowler PV, Sandy JR, Davies A, Russell CJ, Fitzsimons K, Wren Y
Cleft Palate Craniofac J · 2026 Jun · PMID 42294971 · Publisher ↗
Unilateral cleft lip with or without cleft palate demonstrates a consistent 2:1 left-sided predominance across populations. Despite this reproducible directional asymmetry, cleft sidedness has largely been considered des...
Unilateral cleft lip with or without cleft palate demonstrates a consistent 2:1 left-sided predominance across populations. Despite this reproducible directional asymmetry, cleft sidedness has largely been considered descriptive rather than biologically informative. Growing interest in cleft laterality has prompted investigation into associations with morphological, developmental, and functional outcomes. Interpretation is complicated by inconsistent terminology, phenotypic grouping, syndromic classification, and handling of additional congenital anomalies, all of which may alter cohort composition and influence the magnitude or direction of observed associations. This position paper clarifies terminology, highlights methodological challenges, and proposes recommendations for future research to determine whether cleft laterality reflects biologically meaningful craniofacial developmental processes.
Maxillary Sinus Size Evaluation in Children with Unilateral Cleft Lip Palate Using Cone Beam CT.
Vogiatzi T, Sifakakis I, Laspos C … +4 more , Papageorgiou SN, Halazonetis D, Silikas N, Walsh T
Cleft Palate Craniofac J · 2026 Jun · PMID 42294960 · Publisher ↗
ObjectiveTo evaluate and compare the maxillary sinus volume (MSV) and its linear measurements in patients with unilateral cleft lip and palate (UCLP).DesignRetrospective cohort study. Single University Dental Clinic. 20...
ObjectiveTo evaluate and compare the maxillary sinus volume (MSV) and its linear measurements in patients with unilateral cleft lip and palate (UCLP).DesignRetrospective cohort study. Single University Dental Clinic. 20 young patients with non-syndromic UCLP before the secondary alveolar bone grafting were recruited in the last quarter of 2023. Cone Beam Computed Tomography. The maxillary sinus of the non-affected side was used as control. MSV, volume of the anterior and posterior sinus, and maximum length, width and height of the entire sinus, the anterior and posterior part.ResultsMSV was smaller on the cleft side (mean = 10607 mm, SD = 3538 vs. mean 9864 mm, SD = 3243, 03). The volume of the anterior part of the sinus was smaller on the cleft side (median = 4659 mm, IQR = 3687-6055 vs. median 3368 mm, IQR = 2693-5352, 001), whereas the posterior part volume was not. The linear measurements (maximum length, width and height) did not reveal significant difference between the cleft and the non-cleft side (entire sinus - anterior - posterior parts). The anterior/posterior height ratio was smaller on the cleft side (mean = 0.991, SD = 0.091 vs. mean 0.931, SD = 0.106, 001).ConclusionThe MSV is significantly smaller on the cleft side in young patients with UCLP. This hypoplasia is significantly associated with the anterior part of the maxillary sinus. Additionally, there are indications of a restricted vertical development of the maxillary sinus on the cleft side.
Combined Multi-Axis Tessier Clefts: Surgical Management and Early Functional Outcomes From a Tertiary Center.
Allam K, Gameel S, Bakri S
Cleft Palate Craniofac J · 2026 Jun · PMID 42283123 · Publisher ↗
BackgroundRare craniofacial clefts are among the most complex anomalies encountered in reconstructive surgery. Although isolated Tessier clefts are well described, patients with multiple independent craniofacial cleft ax...
BackgroundRare craniofacial clefts are among the most complex anomalies encountered in reconstructive surgery. Although isolated Tessier clefts are well described, patients with multiple independent craniofacial cleft axes remain exceptionally rare, and their anatomical patterns, staged reconstructive burden, and early functional outcomes remain incompletely characterized.Patients and MethodsA retrospective review was conducted of patients with combined craniofacial clefts treated at a tertiary craniofacial center between 2015 and 2024. Combined clefts were defined as 2 or more independent craniofacial cleft axes according to the Tessier classification.ResultsThirteen patients met inclusion criteria. Ten (77%) underwent staged reconstruction at our institution, with a mean of 3.1 operative stages per treated patient. Orbital involvement was present in nine patients and palatal clefts in 6. Skeletal reconstruction was required in three patients. Early functional outcomes were generally acceptable during follow-up, although residual deformities and speech-related sequelae persisted in some referred revision cases. Minor wound infection occurred in three patients, and hypertrophic or widened scarring in 4.ConclusionsCombined multi-axis craniofacial clefts represent a rare and surgically demanding subset of congenital anomalies requiring function-prioritized staged reconstruction and continued multidisciplinary follow-up throughout growth.
Cleft Lip and Palate Awareness in General Population of North India.
Kumari S, K V N, Rai S … +2 more , Chug A, Dixit A
Cleft Palate Craniofac J · 2026 Jun · PMID 42283122 · Publisher ↗
ObjectiveThis study aimed to assess public knowledge, attitudes, and awareness concerning cleft lip and/or palate (CL/P) among the general population of North India, seeking to identify existing knowledge gaps, misconcep...
ObjectiveThis study aimed to assess public knowledge, attitudes, and awareness concerning cleft lip and/or palate (CL/P) among the general population of North India, seeking to identify existing knowledge gaps, misconceptions, and readiness for awareness initiatives.DesignA cross-sectional, questionnaire-based survey.SettingDental outpatient department (OPD) of a tertiary healthcare institute in North India.Patients, ParticipantsA total of 648 participants (357 males, 291 females; aged 18-75 years), recruited via convenience sampling from the dental OPD visitors between May 2025 and August 2025. Participants were 18 years or above and could read English/Hindi.InterventionsNone.Main Outcome Measure(s)Public knowledge of CL/P etiology, risk factors, treatment options, support systems, perceived social impact, and attitudes toward CL/P and public education, measured via a 14-item closed-ended questionnaire.ResultsA majority of respondents (78.86%) reported general awareness of CL/P, but detailed knowledge about etiology (eg, maternal age, smoking, alcohol as risk factors), comprehensive multidisciplinary management (recognized by only 2.16%), and available support systems such as governmental or non-governmental organizations, were significantly limited. Misconceptions about CL/P being acquired or contagious persisted. Positive attitudes included belief in productive lives for affected individuals and willingness to support CL/P initiatives. Knowledge status was significantly associated with gender and education level.ConclusionsDespite general familiarity, significant knowledge gaps exist regarding CL/P in North India. Targeted public health strategies are urgently needed to correct misconceptions, promote multidisciplinary care awareness, and improve knowledge of available support organizations to enhance access to care and social inclusion.
Comparison of Palatal Mucosa Thickness in Individuals With and Without Cleft lip and Palate.
Costa SMDS, de Oliveira RF, Zangrando MSR … +4 more , de Azevedo-Silva LJ, Ferrairo BM, Esper LA, de Almeida ALPF
Cleft Palate Craniofac J · 2026 Jun · PMID 42267476 · Publisher ↗
ObjectiveTo compare palatal mucosal thickness between individuals with and without cleft lip and palate (CLP).DesignRetrospective observational study.SettingsTertiary-level craniofacial referral center.ParticipantsThirty...
ObjectiveTo compare palatal mucosal thickness between individuals with and without cleft lip and palate (CLP).DesignRetrospective observational study.SettingsTertiary-level craniofacial referral center.ParticipantsThirty-eight cone-beam computed tomography (CBCT) scans from individuals without CLP (control group, C) and 60 scans from individuals with CLP (test group, T).Main Outcome MeasuresPalatal mucosal thickness was measured in sagittal CBCT slices at the cementoenamel junction (CEJ) of the canine (Ca), first premolar (P1), second premolar (P2), first molar (M1), and second molar (M2). Additional measurements were obtained at 3-mm intervals from the CEJ toward the mid-palatal suture (R3, R6, R9, and R12).ResultsIn group C, the thinnest mucosa was observed at M1 (2.95 ± 1.11 mm), whereas P2 showed the greatest thickness (3.72 ± 1.20 mm). In group T, P1 presented the lowest thickness (4.27 ± 1.30 mm), and M2 the highest (4.67 ± 1.93 mm). A significant difference was observed between groups ( < .001). In individuals with CLP, palatal vault height was associated with CAR6 and M1R6, whereas the number of palatoplasties was associated only with P1R6.ConclusionIn individuals with CLP, the region extending from the distal aspect of the canine to the mesial aspect of the palatal root of the first molar appears to represent the most favorable anatomical region for palatal soft tissue graft harvesting.
Predictive Model for Bone Availability in Patients With Unilateral Cleft Lip and Palate: A Machine Learning Approach.
Atapek MM
Cleft Palate Craniofac J · 2026 Jun · PMID 42267402 · Publisher ↗
ObjectiveTo develop a predictive model for estimating cortical bone thickness at any maxillary location in patients with unilateral cleft lip and palate (UCLP).DesignRetrospective cross-sectional cohort study with machin...
ObjectiveTo develop a predictive model for estimating cortical bone thickness at any maxillary location in patients with unilateral cleft lip and palate (UCLP).DesignRetrospective cross-sectional cohort study with machine learning.SettingUniversity hospital, Department of Oral and Maxillofacial Radiology.Patients, ParticipantsFifty patients with non-syndromic UCLP and 50 age- and gender-matched controls (total = 100). Mean age: UCLP 14.8 ± 5.1 years; controls 16.5 ± 4.6 years. Age range: 8 to 27 years.InterventionsAll participants underwent CBCT (0.2 mm voxel, 14 × 16 cm FOV). Cortical bone thickness was measured at 4, 6, 8, 10, and 12 mm from the alveolar crest across six interradicular regions, yielding 4500 data points.Main Outcome Measure(s)Cortical bone thickness; model performance metrics (, RMSE); feature importance; accuracy by region and depth.ResultsRandom Forest regression explained 75% of variance (patient-level cross-validation: = 0.75, RMSE = 0.102 mm). Anatomical region was the strongest predictor (0.38), followed by depth (0.27), age (0.18), cleft status (0.12), and side (0.05). Best accuracy in posterior regions ( = 0.84) and at 12 mm depth ( = 0.81); lowest in anterior regions ( = 0.72) and at 4 mm depth ( = 0.69). The model identified high-risk zones with 89% sensitivity (AUC = 0.94). External validation has not yet been performed; the author welcomes collaboration with other centers for independent testing.ConclusionsThis model provides accurate, patient-specific predictions of cortical bone thickness in UCLP patients, assisting in pretreatment risk assessment, surgical planning, and patient counseling.
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