A cephalometric inter-centre comparison of growth in children with cleft lip and palate.
(1/14)
AIM: To examine whether the treatment provided by the Mount Vernon Cleft Team produces craniofacial growth outcomes comparable with that of the Oslo Team. LOCATION: Mount Vernon Hospital, Middlesex, UK. DESIGN: A retrospective cephalometric investigation. SUBJECTS: Seventy-five Mount Vernon children and 150 Oslo children with complete unilateral or bilateral clefts of the lip and palate METHOD: The subjects were matched for age, gender, and cleft type, and their radiographs were digitized. The radiographs from each site were grouped according to patient age (9-11 or 14-16) and cleft classification (bilateral/unilateral). Patients with associated craniofacial anomalies were excluded from the study. RESULTS: Of the four variables studied (SNA, SNPg, NGn, sNANsPG) significant differences in maxillary growth were noted for bilateral and unilateral cleft groups at 14-16 years of age. The soft tissue profile was significantly flatter in bilateral and unilateral Mount Vernon cases at 14-16 years. The craniofacial growth exhibited by the Mount Vernon patients demonstrated 3.9-5.1 degrees reduction in maxillary prominence with respect to the Oslo sample. The bilateral cases from Mount Vernon had greater anterior face heights at 14-16 years. CONCLUSION: The treatment provided by the Mount Vernon Cleft team leads to a reduced maxillary prominence in children aged 14-16 years compared with the Oslo sample. This reduction is statistically significant in unilateral cleft lip and palate. (+info)
Comparative reproducibility of three methods of radiographic assessment of alveolar bone grafting.
(2/14)
The aims of this study were to compare the reproducibility of three radiographic methods of assessing the quality of alveolar bone grafts, namely the Bergland, Kindelan and Chelsea Scales, and evaluate their application in the mixed and permanent dentitions. Additionally the use of occlusal versus periapical radiographs was assessed. Three examiners applied each scale on two occasions to the radiographs of 48 cleft lip and palate patients who had received alveolar bone grafts in 59 sites (11 had bilateral clefts). The agreement between repeated assessments by the same observer at different time points was measured by the kappa statistic, for each of the three assessors and each of the types of radiographic scale in turn. None of the three scales was found to be more reproducible than the others (kappa statistics for intraobserver variation ranged from 0.61 to 0.70). The agreement between observers was also similar across the three radiographic scales (multiple kappa statistics for inter-observer variation ranged from 0.45 to 0.51). Likewise, neither occlusal nor periapical radiographs were found to enable greater reproducibility of assessment. Surprisingly there was a tendency to greater reproducibility in the mixed than in the permanent dentition, which suggests the outcome of alveolar bone grafting may be assessed at an earlier stage than currently adopted. The outcome of alveolar bone grafting in this group of patients was generally successful. (+info)
Prediction of outcomes of secondary alveolar bone grafting in children born with unilateral cleft lip and palate.
(3/14)
The aim of this cross-sectional clinical outcome study using retrospective data capture of treatment histories was to examine the characteristics of children born with unilateral cleft lip and palate (UCLP) in the United Kingdom (UK) who were not grafted at the appropriate age or who had an unsuccessful secondary alveolar bone graft. The subjects were born with complete non-syndromic UCLP between 1.4.82 and 31.3.84 and were aged between 12.0 years and 14.7 years at the time of data collection under the care of 48 cleft teams. The success of secondary alveolar bone grafting was assessed using a modification of the Bergland index. There were no independent predictors for unmet bone grafting need. The outcome of secondary alveolar bone grafting was assessed for 164 subjects; 90 (55%) had a successful first graft. Non-Caucasian (P = 0.037) and increasing age at grafting (P = 0.007) were risk factors for poor outcome. After adjustment for other risk factors, increased age at grafting was independently associated with having a seriously deficient or failed graft (OR = 1.03; 95% CI 1.01-1.06 P = 0.036). All the non-Caucasians in this sample had an unsatisfactory graft. Increasing age in months at grafting and ethnicity are predictors for poor outcome of secondary alveolar bone grafting in children born with UCLP in the UK. (+info)
Postoperative hyperthermia of unknown origin treated with dantrolene sodium.
(4/14)
An 11-year-old girl was scheduled for alveolar cleft bone grafting with an iliac bone under general anesthesia. Anesthesia was performed with 70% nitrous oxide, 30% oxygen, and propofol. On the first and second postoperative day, persistent hyperthermia was observed. Because the administration of diclofenac sodium had not been effective for the hyperthermia, dantrolene sodium was given. Her body temperature gradually dropped and returned to normal level on the fifth postoperative day. The hyperthermia in the present case might have been caused by a rapidly elevated muscle metabolism in response to pain and stress after the propofol anesthesia. The oral administration of dantrolene sodium successfully lowered the patient's high body temperature. (+info)
Alveolar bone grafting: achieving the organisational standards determined by CSAG, a baseline audit at the Birmingham Children's Hospital.
(5/14)
INTRODUCTION: Birmingham Children's Hospital (BCH) is the centre for a regional comprehensive cleft service attempting to implement the national guidelines for minimum standards of care. A national audit of cleft management (CSAG) found that 58% of alveolar bone grafts were successful; published series suggest that success rates can be of the order of 95%. We present the results of an audit of alveolar bone grafting over a 33-month period, after implementation. PATIENTS AND METHODS: A retrospective clinical process audit was taken from the hospital notes and an analysis of radiological outcome by Bergland score was obtained by two independent assessors. RESULTS: The audit highlighted the difficulties of integrating the increased clinical workload. Other difficulties included poorly standardised pre- and postoperative occlusal radiography, inconsistent orthodontic management and a lack of prospective data collection. An 81% success rate for alveolar bone grafting compares favourably to the CSAG study. Of 82 patients, 68 had sufficient data for a retrospective review; 21 were our own patients and 47 were referred into the centralised service. The success of bone grafting as defined by CSAG (including Bergland scores) is based on only two-thirds of the patients as many have their orthodontic treatment managed in more distant units and radiographs are much harder to obtain. Bone grafting later than age 11 years, was true for 28% (6/21) of our BCH patients and 46% (22/47) for those referred to our service. CONCLUSIONS: This audit demonstrates what has been achieved in a re-organised service in the context of Real Politik in the NHS and suggests the areas that require improvement. (+info)
Bone grafting with platelet-rich plasma in alveolar cleft. Case report.
(6/14)
Bone grafting of the alveolus has become an essential part of the contemporary surgical management of oral clefts. The benefits of this procedure are the stabilization of the maxillary arch, elimination of oronasal fistulae, the reconstruction of the soft tissue nasal base support, creation of bony support for subsequent tooth eruption or, when they are not present or not preserved, for implants application. The authors show a case of bone grafting with the aid of platelet-rich plasma (PRP). Because of the difficulties due to the oral cleft and to its surgical reparation (big size of bone defect, hard scars and sclerotic soft tissue) the authors decided to add PRP to a bone graft taken from the chin. PRP contains a high concentration of growth factors and is able to stimulate both wound and bone regeneration. Infact, the authors have observed very good results both in bone integration and in soft tissue reparation. (+info)
Simple preservation of a maxillary extraction socket using beta-tricalcium phosphate with type I collagen: preliminary clinical and histomorphometric observations.
(7/14)
Alveolar atrophy following tooth extraction remains a challenge for future dental implant placement. Immediate implant placement and postextraction alveolar preservation are 2 methods that are used to prevent significant postextraction bone loss. In this article, we report the management of a maxillary tooth extraction socket using an alveolar preservation technique involving placement of a cone of beta-tricalcium phosphate (beta -TCP) combined with type I collagen without the use of barrier membranes or flap surgery. Clinical examination revealed solid new bone formation 9 months after the procedure. At the time of implant placement, histomorphometric analysis of the biopsied bone showed that it contained 62.6% mineralized bone, 21.1% bone marrow and 16.3% residual beta -TCP graft. The healed bone was able to support subsequent dental implant placement and loading. (+info)
Is PRP useful in alveolar cleft reconstruction? Platelet-rich plasma in secondary alveoloplasty.
(8/14)
OBJECTIVE: Cleft lip and palate is a congenital facial malformation with an established treatment protocol. Mixed dentition period is the best moment for correct maxillary bone defect with an alveoloplasty. The aim of this surgical procedure is to facilitate dental eruption, re-establish maxillary arch, close any oro-nasal communication, give support to nasal ala, and in some cases allow dental rehabilitation with osteointegrated implants. STUDY DESIGN: Twenty cleft patients who underwent secondary alveoloplasty were included. In 10 of them autogenous bone graft were used and in other 10 autogenous bone and platelet-rich plasma (PRP) obtained from autogenous blood. Bone formation was compared by digital orthopantomography made on immediate post-operatory and 3 and 6 months after the surgery. RESULTS: No significant differences were found between both therapeutic groups on bone regeneration. CONCLUSION: We do not find justified the use of PRP for alveoloplasty in cleft patients' treatment protocol. (+info)