ObjectivesTo examine and synthesize orthodontic outcomes, including treatment feasibility, spontaneous or orthodontically assisted eruption of maxillary canines, and periodontal or alveolar bone-related outcomes, followi...ObjectivesTo examine and synthesize orthodontic outcomes, including treatment feasibility, spontaneous or orthodontically assisted eruption of maxillary canines, and periodontal or alveolar bone-related outcomes, following secondary alveolar bone grafting (SABG) in patients with cleft lip and palate (CLP).Materials and MethodsA comprehensive PubMed, Scopus, EBSCOhost (MEDLINE), and Cochrane Library search was conducted until February 9, 2025. Randomized controlled trials and observational clinical studies of non-syndromic unilateral or bilateral cleft lip and palate patients who had SABG were eligible. The GRADE framework rated evidence certainty, whereas the Cochrane RoB 2 tool assessed bias in randomized trials and the ROBINS-I instrument in non-randomized research. Narrative synthesis was used due to study design and orthodontic protocol heterogeneity.ResultsFrom 528 records, 6 studies (1 randomized controlled trial and 5 observational cohorts) with 167 patients met the inclusion criteria. The synthesized results showed that thorough orthodontic mechanics and spontaneous and directed canine eruption into the grafted region were possible after graft integration. Cone-beam computed CT showed excellent short- to mid-term periodontal architecture, including alveolar crest height and no prominent bone dehiscences.ConclusionSABG provides a clinically effective foundation for CLP patients' orthodontic rehabilitation. Directed orthodontic tooth movement and maxillary canine eruption are feasible; however, the low certainty of the evidence means that current data should inform clinical judgment and therapy planning rather than treatment efficacy.
ObjectiveTo explore the use of shared decision-making (SDM), a collaborative approach to care between healthcare providers, patients, and their families, in cleft lip and/or palate (CL/P) care.DesignPubMed, CINHAL, Embas...ObjectiveTo explore the use of shared decision-making (SDM), a collaborative approach to care between healthcare providers, patients, and their families, in cleft lip and/or palate (CL/P) care.DesignPubMed, CINHAL, Embase, and Dentistry & Oral Sciences Database were searched for studies reporting on SDM in CL/P pediatric care (<19 years). There were no restrictions on date, language, or study design other than case studies and systematic reviews.ResultsA total of 13 studies were included. Overall, parents reported high levels of perceived involvement in SDM. Pediatric patients shared this view, though the desire for SDM was age-dependent with patients expressing a greater desire for involvement as they aged. Qualitative data revealed 4 main themes, including understanding and knowledge of cleft care and treatment, factors influencing decision-making and patient autonomy, psychosocial and emotional dimensions in decision-making, and moral responsibility and identity in decision-making.ConclusionThe current study highlights that SDM is valued by parents and patients in CL/P care. Further research is needed to understand how SDM can be more clearly integrated into routine CL/P care. Specifically, studies should explore the gap between perceived and actual involvement using standardized SDM measures, as well as identify key barriers and enablers to effective implementation.
ObjectiveThis study assessed psychosocial outcomes in caregivers and quality of life (QoL) in children with Pierre Robin Sequence treated with the Stanford Orthodontic Airway Plate (OAP).DesignA cross-sectional survey wa...ObjectiveThis study assessed psychosocial outcomes in caregivers and quality of life (QoL) in children with Pierre Robin Sequence treated with the Stanford Orthodontic Airway Plate (OAP).DesignA cross-sectional survey was completed by caregivers of 30 OAP-treated children (age at survey: 1.5 ± 1.1 years). Eight open-ended questions and one-sample tests for: Connor-Davidson Resilience Scale-10 (CD-RISC-10); Kessler Psychological Distress Scale-6 (K6); Perceived Stress Scale (PSS); and Pediatric QoL Inventory (PedsQL).ResultsThe mean CD-RISC-10 scores were similar to community samples. The K6 scores were significantly higher (Cohen = 1.01), and PSS scores were lower (Cohen = 0.82) than national averages. The mean PedsQL score was high (89.3 ± 8.4). While 78% of caregivers found OAP demanding, 68% indicated a preference for pursuing OAP earlier.ConclusionsCaregivers reported low stress and high child QoL along with moderate distress, suggestive of the need for ongoing psychosocial supports for caregivers.
To investigate the influence of velopharyngeal (VP) port area on the perception of oral stop versus nasal consonants in child-sized vocal tracts.CVC words were generated using a computational model scaled to 4-, 6-, and...To investigate the influence of velopharyngeal (VP) port area on the perception of oral stop versus nasal consonants in child-sized vocal tracts.CVC words were generated using a computational model scaled to 4-, 6-, and 8-year-old vocal tracts. VP coupling area was systematically varied along a continuum from 0 to 0.1 cm. Stimulus presentation was randomized and presented in a forced-choice perceptual identification task with 4 response options reflecting consonant differences.University laboratory.Thirty untrained adult listeners.Incremental increases in VP coupling area.Listener identification of oral versus nasal consonants.Across all vocal tract ages and vowel contexts (/æ, ɪ, u/), crossover areas at which listeners perceived a nasal instead of an oral stop ranged from 0.014 to 0.035 cm. A one-way multivariate analysis of variance revealed a significant effect of talker age on overall vowel measures, with post hoc tests showing 4-year-olds had smaller crossover areas than older children for /æ/. Crossover areas for child vocal tracts were smaller than those reported for adults (∼0.045-0.046 cm). Variability across vowels and ages, particularly in younger talkers, indicated broader perceptual ambiguity.Small VP openings in child vocal tracts can produce perceptual cues typically associated with hypernasality, even at relatively modest gap sizes. These findings reflect developmental differences in speech production and may inform clinical management of VP insufficiency, emphasizing the perceptual impact of VP gap size on listener judgments.
ObjectiveThe study compared the quality of responses generated by three artificial intelligence chatbots (AICs) for frequently asked questions (FAQs) by caregivers of presurgical nasoalveolar molding (PNAM) therapy.Mater...ObjectiveThe study compared the quality of responses generated by three artificial intelligence chatbots (AICs) for frequently asked questions (FAQs) by caregivers of presurgical nasoalveolar molding (PNAM) therapy.Material and MethodsTwenty-three FAQs on PNAM were posed to WhatsApp Meta AI (Llama 4), ChatGPT-4o, and Gemini 2.5 Flash, under the same conditions. Their responses were evaluated and compared for accuracy, completeness, reliability (Modified DISCERN Score), readability (Flesch-Kincaid readability ease [FKRE] score, simple measure of Gobbledygook [SMOG] index), and global quality score (GQS) by three Orthodontists.ResultsThe responses from Gemini and ChatGPT were more accurate than Meta (medians of 5.67, 5.33, and 5, respectively; < .001). While Gemini outperformed others in completeness (median of 3 vs 2.33, < .001) and reliability (means of 3.41 ± 0.27, 3.13 ± 0.24, and 2.98 ± 0.58, < .001), Meta's responses were more readable (mean FKRE of 43.2 ± 7.97, 39.9 ± 10.3, 36.7 ± 9.17, and SMOG of 9.99 ± 1.32, 11.24 ± 2, 12.46 ± 1.4). For global quality, Gemini fared best, followed by ChatGPT and Meta (median GQS of 4.67, 4.33, and 3.67, respectively; < .001).ConclusionsAll the AICs performed well in terms of accuracy, moderately in completeness and reliability, and sub-optimally in readability. Meta AI showed comparatively lower accuracy and completeness, but better readability than the other two AICs. These highlight the potential use of AI Chatbots as adjunct tools for caregiver education on PNAM and the need to optimize the content before clinical use.
ObjectiveTo investigate Aristaless-like homeobox 4 ALX4), a paired-like homeodomain transcription factor essential for craniofacial morphogenesis, as a susceptibility gene for non-syndromic orofacial cleft (NSOC) and to...ObjectiveTo investigate Aristaless-like homeobox 4 ALX4), a paired-like homeodomain transcription factor essential for craniofacial morphogenesis, as a susceptibility gene for non-syndromic orofacial cleft (NSOC) and to explore its potential regulatory mechanisms in the Han Chinese population.DesignA two-stage case-control genetic association study complemented by exploratory RNA sequencing (RNA-seq) and functional validation.SettingTertiary medical center for orofacial cleft treatment in western China.Patients, ParticipantsDiscovery phase: 2512 NSOC patients and 2255 controls. Replication phase: 2724 NSOC patients and 1263 controls. RNA-seq: 6 patients with non-syndromic cleft lip only (NSCLO) and 2 lip trauma controls. Real-time quantitative PCR (RT-qPCR) validation: 5 NSCLO patients and 5 controls.Interventions Genotyping of 76 tag single-nucleotide polymorphisms (SNPs) within the ALX4 gene region using the SNPscan method, with three SNPs selected for independent replication. Exploratory RNA-seq of lip tissues, RT-qPCR validation, and dual-luciferase reporter assays.Main Outcome Measure(s)Allelic and genotypic associations between ALX4 variants and NSOC subtypes; differential expression of ALX4 and hsa-miR-455-3p in NSCLO tissues; functional validation of microRNA-target interactions.ResultsMultiple ALX4 SNPs showed significant associations with NSOC subtypes after Bonferroni correction ( < 6.58 × 10). rs3861063 demonstrated consistent protective effects for microform cleft lip across both phases. ALX4 and hsa-miR-455-3p were upregulated in NSCLO tissues, confirmed by RT-qPCR. Dual-luciferase assays confirmed that hsa-miR-455-3p directly targets the ALX4 3'UTR (untranslated region), though paradoxical co-upregulation suggests complex regulatory mechanisms.ConclusionsALX4 is a novel NSOC susceptibility gene in Han Chinese, with subtype-specific genetic associations and a complex regulatory interaction involving hsa-miR-455-3p, expanding our understanding of NSOC genetic architecture.
Cleidocranial dysplasia (CCD) is a rare congenital condition characterized by patients presenting with craniofacial anomalies, multiple supernumerary and impacted teeth, retained primary teeth, and delayed eruption, nece...Cleidocranial dysplasia (CCD) is a rare congenital condition characterized by patients presenting with craniofacial anomalies, multiple supernumerary and impacted teeth, retained primary teeth, and delayed eruption, necessitating multi-stage and innovative treatment mechanics to facilitate tooth eruption. This case report highlights the orthodontic management of a 21-year-old female with CCD using a sequential, interdisciplinary approach including the extraction of retained primary and supernumerary teeth, and exposure, bonding, and forced eruption of impacted teeth. The latter was achieved with a custom-fabricated lower appliance and a modified transpalatal arch designed to reinforce anchorage and facilitate simultaneous traction of multiple impacted teeth via a closed surgical technique, achieving their successful retrieval and good orthodontic outcomes.
ObjectiveThis study aimed to compare velopharyrngeal structure in patients with cleft lip and palate following anterior maxillary segmental distraction osteogenesis (AMSDO) or total maxillary distraction osteogenesis (TM...ObjectiveThis study aimed to compare velopharyrngeal structure in patients with cleft lip and palate following anterior maxillary segmental distraction osteogenesis (AMSDO) or total maxillary distraction osteogenesis (TMDO).DesignRetrospective cohort study.SettingAffiliated Hospital of College of Stomatology, Guangxi Medical University.ParticipantsA total of 18 patients with cleft lip and palate were selected.InterventionsAnterior maxillary segmental distraction osteogenesis (N = 9) and Total maxillary distraction osteogenesis (N = 9)Main Outcome MeasuresLateral cephalograms were obtained and the indices of velopharyngeal configuration were measured before distraction (T1) and after distraction (T2).ResultsThe distance of maxillary advancement increased significantly after distraction osteogenesis in both groups, but the difference was not statistically significant. Although nasopharyngeal depth, velar length, velar angle and need ratio increased after both surgeries, these measurements were significantly larger only in TMDO group. Nasopharyngeal depth, velar length, velar angle differed between the groups (P < 0.01, P = 0.002, P < 0.01). No significant intergroup differences between other parameters of the velopharyngeal configuration occurred (P > 0.05).ConclusionThe effect of AMSDO on the structures of the velopharyngeal configurations are minimal, and there is basically no change in the velopharyngeal structure and posterior pharyngeal wall. The postoperative results of TMDO group suggest that it may impair velopharyngeal competence and adaptive compensation of velopharyngeal structure.
ObjectiveTo evaluate national billing patterns for adjunctive rhinoplasty during primary cleft lip repair and assess associated operative characteristics.DesignRetrospective database review.SettingAmerican College of Sur...ObjectiveTo evaluate national billing patterns for adjunctive rhinoplasty during primary cleft lip repair and assess associated operative characteristics.DesignRetrospective database review.SettingAmerican College of Surgeons Pediatric National Surgical Quality Improvement Program, 2016-2021.Patients, ParticipantsPatients undergoing primary cleft lip repair identified using current procedural terminology (CPT) codes 40700-40702, stratified by use of additional rhinoplasty codes (30400-30462).InterventionsPrimary cleft lip repair with or without adjunctive rhinoplasty coding.Main Outcome Measure(s)Use of adjunctive rhinoplasty codes, operative and anesthesia times, surgeon specialty, patient characteristics, and temporal trends in coding.ResultsAmong 8836 patients, 32.9% ( = 2911) were billed adjunctive rhinoplasty codes, most commonly CPT 30460 (78.0%) and 30462 (16.2%). Cases billed with adjunct rhinoplasty codes were associated with longer operative (146.0 vs. 114.6 min; < .001) and anesthesia times (208.8 vs. 172.4 min; < .001), as well as a higher proportion of ASA class II patients (62.4% vs. 55.0%; < .001). Plastic surgeons performed most primary cleft lip repairs (85%) and were more likely to bill adjunct rhinoplasty codes ( = .013).ConclusionsNearly one-third of primary cleft lip repairs include adjunctive rhinoplasty codes. Although comprehensive primary codes exist, differences in interpretation rather than evolving practice patterns may exist. Given the ongoing undervaluation of craniofacial procedures and limited coding mechanisms, clearer guidance is needed to better align billing with contemporary cleft surgical practice.
ObjectiveCraniosynostosis is associated with psychological and neurodevelopmental disorders (PNDD). Using a multi-center database, PNDD incidence in craniosynostosis was compared to controls and by suture.DesignRetrospec...ObjectiveCraniosynostosis is associated with psychological and neurodevelopmental disorders (PNDD). Using a multi-center database, PNDD incidence in craniosynostosis was compared to controls and by suture.DesignRetrospective analysis of TriNetX database (2015-2025).ParticipantsPatients (<18 years) with craniosynostosis were identified using International Classification of Diseases, 10th revision code Q75 without excluding possible syndromes, and unmatched controls were identified without craniofacial diagnoses.ResultsPatients (N = 12,870) with sagittal (36.4%), coronal (35.5%), metopic (22.5%), lambdoid (2.1%), or multi-suture (3.5%) craniosynostosis were compared to controls (N = 22,401,930). Patients with craniosynostosis were significantly more likely to be younger, male, white, and non-Hispanic. Without controlling for sociodemographics, patients with craniosynostosis had higher rates of most PNDD. Speech disorders (14.5%-27.8% vs 4.9%) and motor disorders (5.6%-11.7% vs 1.2%) were frequent concerns. Except for the lambdoid group, patients with craniosynostosis had significantly higher incidence of intellectual disability (1.4%-7.1% vs 0.3%), autism spectrum disorder (3.4%-6.6% vs 2.1%), and scholastic disorder (1.6%-5.7% vs 1.0%). ADHD was significantly higher in the multi-suture (8.2%), metopic (6.3%), and sagittal (5.0%) craniosynostosis groups than in controls (3.6%), while conduct disorder was higher in the metopic (2.9%) and sagittal (1.7%) groups than in controls (1.1%). Only the multi-suture group (9.0%) had higher anxiety than controls (2.9%). All PNDD were higher in multiple-suture craniosynostosis than in single-suture craniosynostosis, with the metopic group having the highest PNDD (2.8%-21.5%).ConclusionsThe incidence of PNDD ranged from 1.1% to 27.8% in patients with craniosynostosis and varied by suture, underscoring the importance of multidisciplinary care and routine developmental surveillance.
ObjectiveThe study examined how various prognostic factors-such as severity of hypernasality, patient's age, nasalance score, type of cleft, and the surgeon performing the procedure-affected the degree of hypernasality a...ObjectiveThe study examined how various prognostic factors-such as severity of hypernasality, patient's age, nasalance score, type of cleft, and the surgeon performing the procedure-affected the degree of hypernasality assessed after Intravelar veloplasty (IVVP) surgery.DesignRetrospective cohort study.SettingThe study was conducted at the Isfahan Cleft Care Team (ICCT), a university-affiliated tertiary care center.Patients/ParticipantsNinety-three nonsyndromic patients with velopharyngeal insufficiency (VPI) secondary to cleft palate who underwent secondary palatal surgery using the IVVP technique between 2006 and 2023.InterventionIVVP secondary surgery.Main Outcome MeasureHypernasality was perceptually assessed at least 6 months following surgery using the CAPS-A protocol and its included rating scale.ResultsNormal resonance was observed after IVVP surgery in 25.8% of patients. The results of the logistic regression analysis showed that younger age at the time of secondary surgery ( = 0.021), lower nasalance score before secondary surgery ( < 0.001), moderate hypernasality before the secondary surgery ( < 0.001), and cleft type (bilateral cleft lip and palate) were predictive of IVVP success.ConclusionBased on the predictive factors identified in this study, the success of IVVP, as well as the likelihood of requiring additional secondary surgeries in individuals with VPI, can be anticipated.
ObjectiveTo evaluate and compare perioperative outcomes and hospital charges between spring-assisted cranioplasty (SAC) and open cranial vault remodeling (OCVR) for single-suture craniosynostosis, with primary analysis f...ObjectiveTo evaluate and compare perioperative outcomes and hospital charges between spring-assisted cranioplasty (SAC) and open cranial vault remodeling (OCVR) for single-suture craniosynostosis, with primary analysis focused on sagittal synostosis.DesignRetrospective cost analysis.SettingSingle tertiary academic center.Patients, ParticipantsPatients diagnosed with single-suture craniosynostosis who underwent surgical repair between 2012 and 2024.InterventionsSurgical repair via SAC or OCVR.Main Outcome Measure(s)Primary outcomes included operating room, anesthesia, intensive care unit (ICU), non-ICU, and total hospital charges. Secondary outcomes included hospital length of stay, estimated blood loss (EBL), transfusion volume, and need for subsequent craniofacial surgery.ResultsAnalysis was restricted to sagittal synostosis to ensure cohort comparability. SAC patients were younger at surgery (3.7 ± 1.1 vs. 16.2 ± 19.2 months; < .001) and had reduced blood donor exposure (0.86 ± 0.45 vs. 1.24 ± 0.77; = .019) and shorter ICU (1.14 ± 0.36 vs. 1.44 ± 0.66 days, = .029) and hospital stay (3.3 ± 0.5 vs. 5.1 ± 0.5 days; < .001) compared with OCVR. Total EBL was similar between groups (18.8 ± 4.0 vs. 19.1 ± 2.7 mL/kg; = .92), although blood loss at spring removal was minimal. ICU charges were lower for SAC ($3846 ± 1695 vs. $4830 ± 2428; = .045), while operating-room, anesthesia, and total hospital charges were comparable ( > .05). Subsequent craniofacial surgery was less frequent following SAC (6.3% vs. 35.6%; = .003), with all SAC reoperations representing planned staged procedures.ConclusionsIn this institutional series of sagittal synostosis repairs, SAC was associated with lower ICU charges, fewer unique blood donor exposures, and fewer subsequent craniofacial procedures compared with OCVR. Although cumulative EBL and operative duration were similar, SAC redistributed blood loss across two shorter operations separated by several months, with minimal blood loss at removal and shorter hospitalization. These findings support SAC as a safe and efficient approach for appropriately selected infants with sagittal synostosis.
ObjectiveTo evaluate comparative speech and surgical outcomes of Furlow Z-plasty (FZP) versus pharyngeal flap (P Flap) in the primary treatment of submucous cleft palate (SMCP).DesignSystematic review and meta-analysis.S...ObjectiveTo evaluate comparative speech and surgical outcomes of Furlow Z-plasty (FZP) versus pharyngeal flap (P Flap) in the primary treatment of submucous cleft palate (SMCP).DesignSystematic review and meta-analysis.SettingPubMed, Embase, MEDLINE, Scopus, and CENTRAL were systematically searched from database inception through June 2025.Patients/ParticipantsEight nonrandomized studies including 376 pediatric patients with SMCP (FZP: = 250; P Flap: = 126).InterventionsPrimary surgical treatment with FZP or P Flap.Main Outcomes and MeasuresThe primary outcomes evaluated were postoperative residual hypernasality (perceptually assessed), velopharyngeal insufficiency (VPI), and reoperation rates. Secondary outcomes included obstructive sleep apnea (OSA) and oronasal fistula formation.ResultsThere was no significant difference in residual hypernasality scores between the 2 interventions (odds ratio [OR] 0.88; 95% confidence interval [CI] [0.41-1.92]; = .757). However, patients undergoing FZP had significantly higher odds of persistent postoperative VPI (OR 2.36; 95% CI [1.14-4.88]; = .020) and reoperation (OR 3.16; 95% CI [1.21-8.22]; = .019). Conversely, FZP was associated with a slightly lower risk of OSA (OR 0.11; 95% CI [0.01-1.06]; = .056). No difference in postoperative fistula formation was observed between the 2 procedures (OR 1.13; 95% CI [0.11-11.61]; = .920).ConclusionsBased on the available evidence, P Flap appears to offer more durable speech outcomes than FZP for the primary treatment of SMCP, with significantly lower reoperation rates. However, the potential for increased OSA risk following P Flap highlights the importance of patient-specific surgical planning that balances velopharyngeal function with airway safety.
ObjectiveCircular RNAs (circRNAs) affect fundamental biological processes, but their genetic effects on nonsyndromic cleft lip with or without cleft palate (NSCL/P) remain unclear.MethodsRNA sequencing of human embryonic...ObjectiveCircular RNAs (circRNAs) affect fundamental biological processes, but their genetic effects on nonsyndromic cleft lip with or without cleft palate (NSCL/P) remain unclear.MethodsRNA sequencing of human embryonic palate mesenchyme cells identified circRNAs and their microRNA response elements (MREs) involved in NSCL/P. Genetic effects of single-nucleotide polymorphisms (SNPs) in MREs were evaluated in 858 NSCL/P cases and 1248 controls. Weighted genetic risk score (wGRS) and the predictive performance were evaluated through areas under the receiver operating characteristic curve (AUC).ResultsWe identified 6272 MREs of 574 known and 53 novel circRNAs harboring 130 SNPs. Rs629772 in circPRKCE and rs365132 in circUIMC1 showed significant associations with NSCL/P [rs629772: OR = 0.82, = 6.45E-03; rs365132: OR = 0.78, = 7.85E-04]. Adding these SNPs to wGRS improved AUC to 0.707 for NSCL/P prediction. Additionally, rs629772 T>C increased the binding affinity of hsa-miR-628-5p and circPRKCE, and rs365132 G>T increased the binding of hsa-miR-374c-3p and hsa-miR-3916 to circUIMC1, followed by the alteration of 9, 6, and 65 target genes for hsa-miR-628-5p, hsa-miR-374c-3p, and hsa-miR-3916, respectively, which participated in key biological pathways.ConclusionThis study indicated genetic effects in circRNA MREs associated with NSCL/P, offering insights into the genetic regulation and functional mechanisms of the disease.
BackgroundIndia has one of the world's largest burdens of cleft lip and palate (CLP), yet lacks a national outcomes registry or standardized system for cleft care evaluation. The is a multicentric national initiative to...BackgroundIndia has one of the world's largest burdens of cleft lip and palate (CLP), yet lacks a national outcomes registry or standardized system for cleft care evaluation. The is a multicentric national initiative to assess current treatment outcomes for patients with non-syndromic unilateral CLP for 5-, 12-, and 20-year-old age groups.MethodsFourteen cleft care centers across India participated in this cross-sectional study. Standardized protocols for collecting data were formulated with input from the Study Steering Committee, validated through pilot testing, and employed for data collection. Data collected included intra-oral and extraoral photographs, study models, radiographs, surgical information, oral health assessments, speech recordings, hearing evaluations, psychosocial measures, and the intelligibility in context scale questionnaire. In this paper, we present the dentofacial outcomes. Skeletal relationships were analyzed using ANB, SNA, and SNB angles derived from cephalometric radiographs; dental arch relationships were evaluated using the 5-year or modified GOSLON indices; and nasolabial esthetics were assessed with the Asher-McDade index.ResultsData from 294 non-syndromic unilateral cleft lip and palate (UCLP) patients aged 5 (n = 72), 12 (n = 155), and 20 years (n = 67) were analyzed. Reliability testing showed strong intra and inter-rater agreement for all indices and cephalometric data (class correlation coefficient > 0.9). Nearly half of 12 year olds (46.5%) and more than half of 20 year olds (58.7%) demonstrated a Class III skeletal relationship (ANB < 0). Poor to very poor dental arch relationships (score > 3) were observed in 45%, 48%, and 43% of the 5-, 12-, and 20-year groups, respectively. Nasolabial esthetic outcomes were rated poor to very poor in 24.3% of 5 year olds, 25% of 12 year olds, and 55.4% of 20 year olds.ConclusionThis multicentric cleft outcomes audit in India demonstrated suboptimal skeletal, dental, and nasolabial outcomes when benchmarked against international standards. These findings highlight an urgent need for the centralization of cleft services, implementation of systematic national outcome monitoring, and adoption of standardized multidisciplinary care pathways to improve the quality and consistency of cleft management across India.
ObjectiveTo determine whether initial lip asymmetry predicts long-term symmetry changes in patients with unilateral cleft lip and alveolus (UCLA) and to characterize patterns of region-specific morphic change relevant to...ObjectiveTo determine whether initial lip asymmetry predicts long-term symmetry changes in patients with unilateral cleft lip and alveolus (UCLA) and to characterize patterns of region-specific morphic change relevant to orthodontic planning.DesignRetrospective observational study.SettingUniversity-based orthodontic clinic.PatientsAmong 80 UCLA patients treated between 2008 and 2023, 42 with standardized frontal photographs at two treatment stages (before active orthodontic treatment [T1] and before comprehensive orthodontic treatment [T2]) under rest and smile conditions were included.Main Outcome MeasuresTen lip-related measures (7 linear distances, 3 angular variables) were obtained from frontal images, and left-to-right asymmetry was calculated as the difference between the noncleft and cleft sides (noncleft-cleft). Longitudinal change was defined as Δ = T2 - T1. Paired tests with effect sizes (Cohen's dz) and false discovery rate adjustment were used, and importance scores were used to visualize the combined magnitude and robustness of changes.ResultsOverall lip symmetry tended to improve from T1 to T2 in both rest and smile conditions. Measure 2 (peak of Cupid's bow to oral commissure distance) and Measure 6 (lower lip width) exhibited negative Δ values with moderate effect sizes (dz = 0.39-0.42) in unadjusted analyses. After adjustment for multiple comparisons, no comparisons remained statistically significant; however, effect-size patterns suggested consistent, moderate improvement in symmetry in regions around the Cupid's bow.ConclusionsInitial lip asymmetry influences long-term symmetry changes in UCLA patients. Quantitative assessment of region-specific symmetry changes may support interdisciplinary planning focused on individualized soft-tissue outcomes.
ObjectiveThis study aimed to evaluate the maturation stages of the midpalatal (MPS) and zygomaticomaxillary (ZMS) sutures, as well as the spheno-occipital synchondrosis (SOS), in patients with pycnodysostosis (PYCD) comp...ObjectiveThis study aimed to evaluate the maturation stages of the midpalatal (MPS) and zygomaticomaxillary (ZMS) sutures, as well as the spheno-occipital synchondrosis (SOS), in patients with pycnodysostosis (PYCD) compared with controls, and to explore their associations with age and sex.DesignCross-sectional study was matched by sex and age with a control group.SettingIn a secondary care center for patients with rare diseases in the state of Ceara (Brazil).Participants18 participants (9 PYCD, 9 controls).InterventionsSutures were analyzed using cone-beam computed tomography (CBCT) based on established classification systems.Main Outcome MeasuresThe stage of suture maturation was the main evaluation parameter. MPS and ZMS were evaluated for fusion stages, while SOS ossification was assessed using a 5-stage maturation scale. Statistical analyses included Pearson's chi-square, Fisher's exact tests, and Spearman's correlations to assess associations between suture stages and demographic or clinical variables.ResultsSignificant differences were observed between the groups in the maturation stages of the ZMS ( = .009) and MPS ( = .029), with earlier fusion in patients with PYCD, independent of age. SOS showed no significant differences between groups but exhibited a strong correlation with age ( = .001, = .727). Associations with sex were observed only for the SOS ( < .001), indicating earlier fusion in females.ConclusionsOur findings confirm differences in the fusion stages of the MPS, and ZMS. However, further studies are needed to better understand the influence of sex and age on suture fusion, with age being a particularly significant parameter for the SOS.
BackgroundThe diagnosis of cleft lip and/or palate (CL/P) in a child triggers various emotional processes for both the child and their parents.ObjectiveThis systematic review aimed to evaluate the emotional impact and re...BackgroundThe diagnosis of cleft lip and/or palate (CL/P) in a child triggers various emotional processes for both the child and their parents.ObjectiveThis systematic review aimed to evaluate the emotional impact and reactions of parents when they receive a diagnosis of CL/P for their child, whether during pregnancy or at birth.MethodsThe review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with PROSPERO. Comprehensive search strategies were used across multiple electronic databases, including EMBASE, PubMed/MEDLINE, Web of Science, Scopus, LILACS, and LIVIVO. Gray literature sources such as Google and ProQuest Dissertations & Theses were also explored.ResultsThe initial search retrieved 2380 references. After full-text screening of 19 articles, 10 were included in the final review, along with 9 additional articles identified through reference lists and gray literature. The included studies addressed at least one of the following themes: emotional reactions, psychological impact, and the parent-child relationship following the diagnosis. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal tool, with most studies rated as having low to moderate risk of bias.ConclusionParents whose children have CL/P often experience significant emotional distress, particularly at the time of diagnosis. This impact can be mitigated when the diagnosis is delivered by specialized teams offering comprehensive support. In addition, the high financial burden related to treatment and ongoing multidisciplinary care increases stress levels, intensifying the emotional challenges faced by families.