| 1. |
- Klintö, Kristina, et al.
(författare)
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Coverage, reporting degree and design of the Swedish quality registry for patients born with cleft lip and/or palate
- 2020
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Ingår i: BMC Health Services Research. - : BMJ Publishing Group Ltd. - 1472-6963. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The objective of the Swedish cleft lip and palate (CLP) registry is to promote quality control, research and improvement of treatment, by comparison of the long-term results of surgery, orthodontics and speech from all six Swedish CLP centres. The purpose of the study was to investigate the coverage and reporting degree of the Swedish CLP registry, and to describe the design of the registry and discuss questions of reliability and validity of the data included.Methods: All six Swedish CLP centres participate in the registry. All children in Sweden with cleft lip and/or cleft palate, born from 2009 onwards, are included in the registry. Baseline data such as cleft type (ICD-10 diagnosis), heredity, birth weight and additional deformities and/or syndromes, as well as pre-surgical treatment, are recorded at first visit. Data on surgical treatment are recorded continuously. Treatment outcome regarding dentofacial development and speech are recorded at follow-ups at 5, 10, 16 and 19 years of age. Data on dentofacial development are also recorded 1 year after orthognathic surgery. In addition, data on babbling and speech are recorded at 18 months of age. Coverage degree and reporting degree of surgery was assessed by comparison with registrations in the Swedish Central patient registry. Reporting degree of orthodontic and speech registrations at 5 years of age was assessed by comparison with registrations at baseline.Results: The average coverage degree for children born 2009 to 2018 was 95.1%. For cleft-related surgeries, the average reporting degree was 92.4%. Average reporting degree of orthodontic registrations and speech registrations at age 5 years was 92 and 97.5% respectively.Conclusion: In order to achieve valid and reliable data in a healthcare quality registry, the degree of coverage and reporting needs to be high, the variables included should be limited and checked for reliability, and the professionals must calibrate themselves regularly. The Swedish CLP registry fulfils these requirements.
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| 2. |
- Chaudhry, Mahwash, et al.
(författare)
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The 5-year-olds' index, the GOSLON Yardstick index, and the modified Huddart/Bodenham index among children with complete unilateral cleft lip and palate : A methodological study
- 2018
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Ingår i: International Journal of Orthodontic Rehabilitation. - : MM Publishers. - 2542-5579 .- 2349-5243. ; 9:3, s. 101-106
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Tidskriftsartikel (refereegranskat)abstract
- Background: The function of many orthodontic indices is to assess occlusion in patients born with a cleft. The aim of this study was to assess the intra- and interexaminer reliability for the 5-year-olds' (5YO) index, the GOSLON Yardstick index, and the modified Huddart/Bodenham (MHB) index in dental casts of children with complete unilateral cleft lip and palate (UCLP); a further aim is to compare the indices to each other.Methods: Forty dental casts from 5-year-old nonsyndromic patients with complete UCLP who had undergone primary surgery at Skåne University Hospital in Malmö, Sweden, were examined by two examiners: one orthodontic specialist and one general dentist.Results: Intraexaminer reliability for 5YO and MHB had a substantial (κ: 0.61–0.80) to almost perfect agreement ( κ: 0.81–1.00) and GOSLON Yardstick moderate (κ: 0.41–0.60) to almost perfect agreement. Grouped teeth or single-tooth MHB had an almost perfect agreement for both examiners. Interexaminer reliability for 5YO had a moderate agreement, whereas GOSLON Yardstick and MHB had a fair agreement (κ: 0.21–0.40). Grouped teeth or single-tooth MHB had an almost perfect agreement.Conclusions: The 5YO index illustrates the occlusion and has a high degree of reliability for an experienced orthodontist. The GOSLON Yardstick also illustrates the occlusion, but reliability between assessments is lower. MHB index can be used with a high degree of reliability when categorized as grouped or single tooth, but the judgment of total occlusion is more uncertain.
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| 3. |
- Cornefjord, Måns, et al.
(författare)
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A systematic review of differences in outcome between one and two stage palate repair in cleft lip and palate
- 2023
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Ingår i: Journal of Plastic Surgery and Hand Surgery. - 2000-656X. ; 58, s. 132-141
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Forskningsöversikt (refereegranskat)abstract
- The aim of this systematic review was to determine whether one-stage palatoplasty for children born with cleft lip and palate shows overall advantages in outcome compared with two-stage palatoplasty. The included studies were controlled studies of syndromic and non-syndromic children born with unilateral cleft lip and palate, bilateral cleft lip and palate, or isolated cleft palate. The interventions studied were one-stage palatoplasty and two-stage palatoplasty starting with the soft palate. The outcomes were facial growth, speech, hearing, presence of fistulae, other complications related to surgery, health-related quality of life, and health economics. In total, 14 original studies were included. Results were dichotomized into showing advantage for one- or two-stage palatoplasty for the respective outcome and compared with the results from six included systematic reviews. No overall advantage for either surgical strategy was found for any of the outcome measures. The certainty of evidence was highest for the presence of fistulae, followed by facial growth and speech. For several outcomes, the quality of the existing evidence was too low to allow for any conclusions to be drawn. Neither one- nor two-stage palatoplasty showed significant advantages in clinical outcomes compared with the other. Other aspects such as ethics, economics, or surgeon's preference might hence be of more importance. Homogenous choices of outcome measures and defined minimal clinically important differences would facilitate further research.
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| 4. |
- Klintö, Kristina, et al.
(författare)
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Long-term speech outcome after anterior distraction osteogenesis of the maxilla in patients with cleft lip and palate.
- 2023
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Ingår i: Journal of Plastic Surgery and Hand Surgery. - : Medical Journals Sweden. - 2000-656X .- 2000-6764. ; 58, s. 110-114
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Tidskriftsartikel (refereegranskat)abstract
- Advancement of the maxilla may increase the distance between the soft palate and the posterior pharyngeal wall in patients with cleft lip and palate, implying a risk of velopharyngeal dysfunction. The aim was to evaluate long-term speech outcome in a consecutive series of patients treated with distraction osteogenesis (DO). Fourteen out of the 16 patients agreed to participate. A long-term speech follow-up was performed 1.5 to 13.5 years after DO. For two participants, audio recordings before DO were missing, and for another one, it was incomplete. The percentage of consonants correct (PCC) based on phonetic transcription and perceived velopharyngeal competence rated on a three-point scale were assessed before and after DO by three independent judges, based on audio recordings of reading of standardised sentences. Also, the participants were asked how they perceived their speech after DO. Changes in PCC were insignificant. Four participants perceived deteriorated speech related to DO. In two cases, the subjective deterioration did not correlate to results from perceptual assessment. In two others, the subjective deterioration correlated with the perceptual assessment, and the velopharyngeal function was judged as being incompetent after DO. After secondary velopharyngeal surgery, velopharyngeal function improved to competent in one case and marginally incompetent in the other. The results need to be interpreted with caution due to methodological limitations but indicate that some patients develop deteriorated velopharyngeal function after DO. The impact on articulation needs to be further explored. It is important that patients are informed before treatment of the risk of velopharyngeal dysfunction after DO.
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| 5. |
- Vicente, António, et al.
(författare)
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Do preterm-born children and adolescents have greater need for dental care as compared to full term-born controls?
- 2022
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Ingår i: BMC Oral Health. - : Springer Science and Business Media LLC. - 1472-6831. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Preterm birth has been shown to cause various long-term health issues. Children who were born preterm have also been observed to have more dental behaviour management problems (DBMP) during dental examinations and treatment than children born full term. It is known that dental radiographic examinations can be uncomfortable and cause anxiety in paediatric patients. Thus, our aims were to retrospectively compare dental care related examinations and treatments carried out in three different age intervals (3–6 years, 7–12 years, and 13–19 years) among preterm- and full-term born children and adolescents. Methods: The present study included 311 patient files: 122 very preterm–born and 33 extremely preterm–born children and adolescents (< 32 gestational weeks). A matched control group of 156 full term–born children and adolescents (≥ 37 gestational weeks) was analysed for comparison. Various factors, including DBMP, missed appointments, dental caries, and radiographic examinations, were retrieved from the dental records for three age intervals: 3–6 years, 7–12 years, and 13–19 years. Results: Extremely preterm–born children missed significantly more dental appointments and presented with more DBMP during dental examinations and treatment than full term–born children in the 3–6-year age group; the same was observed for the very preterm–born in the 7–12-year age group. No significant differences in DBMP during bitewing and periapical examinations or in number of bitewing, periapical and panoramic radiographs occurred between the groups in any age interval. Conclusion: Preterm–born children and adolescents may need more flexibility in booking and receive reminders for scheduled visits with the general dental team. Due to the non-significant differences in dental care related oral examinations and treatments, the same dental care service may be applied to the preterm- and full-term born children and adolescents.
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| 6. |
- Vicente, António, et al.
(författare)
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Quantitative assessment of cleft volume and evaluation of cleft's impact on adjacent anatomical structures using CBCT imaging
- 2024
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Ingår i: Oral Radiology/Springer. - : Springer. - 0911-6028 .- 1613-9674. ; 40:2, s. 295-303
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To determine pre-operative cleft volume and evaluate cleft´s impact on surrounding anatomical structures in children and adolescents with orofacial clefts using cone bean computed tomography (CBCT) imaging.Methods: The present retrospective study retrieved CBCT examinations of 68 patients from a previous study. The examinations had been exposed either before (n = 53) or after (n = 15) alveolar bone grafting. Pre-operative volume of cleft was determined, and type and location were evaluated. Morphological changes on the adjacent anatomical structures, including the incisive foramen, the nasal septum and floor, and the inferior turbinate, were assessed.Results: Mean bilateral cleft volume was 0.76 cm3, while mean unilateral cleft volume was 1.08 cm3; the difference was significant (p < 0.001). Variation in cleft volume, however, was large. The incisive foramen was not visible in the majority of cases with bilateral clefts (71%); the difference was significant (p = 0.001). In cases with unilateral clefts, the nasal septum in 87% was curved towards the cleft or graft side. Also, the mean size of the widest part of the inferior turbinate was 8.8 mm on the cleft or graft side and 10.4 mm on the non-cleft side. The difference was significant (p < 0.001).Conclusions: When required, CBCT is a feasible method for quantitatively illustrating alveolar clefts and their impact on the morphological development of surrounding structures. Variation in cleft volume was large.
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| 7. |
- Wiedel, Anna-Paulina, et al.
(författare)
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A cost minimization analysis of early correction of anterior crossbite-a randomized controlled trial
- 2016
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Ingår i: European Journal of Orthodontics. - : Oxford University Press. - 0141-5387 .- 1460-2210. ; 38:2, s. 140-145
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Economic evaluations provide an important basis for allocation of resources and health services planning. The aim of this study was to evaluate and compare the costs of correcting anterior crossbite with functional shift, using fixed or removable appliances (FA or RA) and to relate the costs to the effects, using cost-minimization analysis. DESIGN, SETTING, AND PARTICIPANTS: Sixty-two patients with anterior crossbite and functional shift were randomized in blocks of 10. Thirty-one patients were randomized to be treated with brackets and arch wire (FA) and 31 with an acrylic plate (RA). Duration of treatment and number and estimated length of appointments and cancellations were registered. Direct costs (premises, staff salaries, material, and laboratory costs) and indirect costs (the accompanying parents' loss of income while absent from work) were calculated and evaluated with reference to successful outcome alone, to successful and unsuccessful outcomes and to re-treatment when required. Societal costs were defined as the sum of direct and indirect costs. INTERVENTIONS: Treatment with FA or RA. RESULTS: There were no significant differences between FA and RA with respect to direct costs for treatment time, but both indirect costs and direct costs for material were significantly lower for FA. The total societal costs were lower for FA than for RA. LIMITATIONS: Costs depend on local factors and should not be directly extrapolated to other locations. CONCLUSION: The analysis disclosed significant economic benefits for FA over RA. Even when only successful outcomes were assessed, treatment with RA was more expensive. TRIAL REGISTRATION: This trial was not registered. PROTOCOL: The protocol was not published before trial commencement.
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| 8. |
- Wiedel, Anna-Paulina, et al.
(författare)
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A randomized controlled trial of self-perceived pain, discomfort, and impairment of jaw function in children undergoing orthodontic treatment with fixed or removable appliances
- 2016
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Ingår i: Angle orthodontist. - : Allen Press. - 0003-3219 .- 1945-7103. ; 86:2, s. 324-330
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To compare patients' perceptions of fixed and removable appliance therapy for correction of anterior crossbite in the mixed dentition, with special reference to perceived pain, discomfort, and impairment of jaw function. MATERIAL AND METHODS: Sixty-two patients with anterior crossbite and functional shift were recruited consecutively and randomized for treatment with fixed appliances (brackets and archwires) or removable appliances (acrylic plates and protruding springs). A questionnaire, previously found to be valid and reliable, was used for evaluation at the following time points: before appliance insertion, on the evening of the day of insertion, every day/evening for 7 days after insertion, and at the first and second scheduled appointments (after 4 and 8 weeks, respectively). RESULTS: Pain and discomfort intensity were higher for the first 3 days for the fixed appliance. Pain and discomfort scores overall peaked on day 2. Adverse effects on school and leisure activities were reported more frequently in the removable than in the fixed appliance group. The fixed appliance group reported more difficulty eating different kinds of hard and soft food, while the removable appliance group experienced more speech difficulties. No significant intergroup difference was found for self-estimated disturbance of appearance between the appliances. CONCLUSIONS: The general levels of pain and discomfort were low to moderate in both groups. There were some statistically significant differences between the groups, but these were only minor and with minor clinical relevance. As both appliances were generally well accepted by the patients, either fixed or removable appliance therapy can be recommended.
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| 9. |
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| 10. |
- Wiedel, Anna-Paulina, et al.
(författare)
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An analysis of complications in secondary bone grafting in patients with unilateral complete cleft lip and palate
- 2016
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Ingår i: Journal of Plastic Surgery and Hand Surgery. - : Taylor & Francis. - 2000-656X .- 2000-6764. ; 50:2, s. 63-67
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of this investigation was to assess the outcome of secondary alveolar bone grafts 6 months after the procedure and examine the possible influence of patient sex, age at surgery, cleft width, and dehiscence of mucosa and sequestered bone at 2 weeks. Methods: Thirty-nine consecutive patients with unilateral complete cleft lip and palate were reconstructed with secondary alveolar bone grafting. Age at surgery ranged from 7.3-12.5 years (mean = 8.6). Cleft width varied between 2.2-14 mm (mean = 7.3). Bone was harvested either from the iliac crest or from the chin. Two-dimensional dental radiographs of the cleft area were taken before and 6 months after surgery Results: Two weeks after surgery, 10 patients had minor dehiscence of the sutured gingival tissues and five had bone sequesters. However, only one of the treatments turned out to be unsuccessful with a Bergland index of IV. Twenty-nine patients had an initial uneventful course; but, at a follow-up 6 months later, two patients had a Bergland index of III and four a Bergland index of IV. In three of these cases, there were circumstances that could have contributed to the lack of success; but, in the remaining three, no such circumstances could be identified Conclusion: The success rate of secondary bone grafting is high, and initial wound healing problems do not necessarily lead to a failed reconstruction. Failure may be related to factors such as exposed tooth enamel during an operation, postoperative infection, and poor compliance. Still, failed operations occur without any obvious causes.
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| 11. |
- Wiedel, Anna-Paulina
(författare)
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Fixed or removable appliance for early orthodontic treatment of functional anterior crossbite : evidence-based evaluations of success rate of interventions, treatment stability, cost-effectiveness and patients perceptions
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Anterior crossbite with functional shift also called pseudo Class III isa malocclusion in which the incisal edges of one or more maxillaryincisors occlude with the incisal edges of the mandibular incisorsin centric relationship: the mandible and mandibular incisors arethen guided anteriorly in central occlusion resulting in an anteriorcrossbite.Early correction, at the mixed dentition stage, is recommended,in order to avoid a compromising dentofacial condition whichcould result in the development of a true Class III malocclusionand temporomandibular symptoms. Various treatment options areavailable. The method of choice for orthodontic correction of thiscondition should not only be clinically effective, with long-termstability, but also cost-effective and have high patient acceptance, i.e.minimal perceived pain and discomfort. At the mixed dentition stage,the condition may be treated by fixed (FA) or removable appliance(RA). To date there is insufficient evidence to determine the preferredmethod.The overall aim of this thesis was therefore to compare andevaluate the use of FA and RA for correcting anterior crossbitewith functional shift in the mixed dentition, with special referenceto clinical effectiveness, stability, cost-effectiveness and patientperceptions. Evidence-based, randomized controlled trial (RCT)methodology was used, in order to generate a high level of evidence.The thesis is based on the following studies:The material comprised 64 patients, consecutively recruited fromthe Department of Orthodontics, Faculty of Odontology, Malmö University, Sweden and from one Public Dental Health Service Clinicin Malmö, Skane County Council, Sweden. The patients were nosyndrome and no cleft patients. The following inclusion criteria wereapplied: early to late mixed dentition, anterior crossbite affecting oneor more incisors with functional shift, moderate space deficiency inthe maxilla, no inherent skeletal Class III discrepancy, ANB angle>0º, and no previous orthodontic treatment. Sixty-two patients agreedto participate and were randomly allocated for treatment either withFA with brackets and wires, or RA, comprising acrylic plates withprotruding springs. Paper I compared and evaluated the efficiency of the two differenttreatment strategies to correct the anterior crossbite with anteriorshift in mixed dentition. Paper II compared and evaluated thestability of the results of the two treatment methods two years afterthe appliances were removed. In Paper III, the cost-effectiveness ofthe two treatment methods was compared and evaluated by costminimizationanalysis. Paper IV evaluated and compared the patient´sperceptions of the two treatment methods, in terms of perceived pain,discomfort and impairment of jaw function. The following conclusions were drawn from the results:Paper I• Anterior crossbite with functional shift in the mixed dentitioncan be successfully corrected by either fixed or removableappliance therapy in a short-term perspective.• Treatment time for correction of anterior crossbite withfunctional shift was significantly shorter for FA compared toRA but the difference had minor clinical relevance. Paper II• In the mixed dentition, anterior crossbite affecting one ormore incisors can be successfully corrected by either fixedor removable appliances, with similarly stable outcomes andequally favourable prognoses.• Either type of appliance can be recommended. Paper III• Correction of anterior crossbite with functional shift usingfixed appliance offers significant economic benefits overremovable appliances, including lower direct costs formaterials and lower indirect costs. Even when only successfuloutcomes are considered, treatment with removable applianceis more expensive. Paper IV• The general levels of pain intensity and discomfort were lowto moderate in both groups.• The level of pain and discomfort intensity was higher for thefirst three days in the fixed appliance group, and peaked onday two for both appliances.• Adverse effects on school and leisure activities as well asspeech difficulties were more pronounced in the removablethan in the fixed appliance group, whereas in the fixedappliance group, patients reported more difficulty eatingdifferent kinds of hard food.• Thus, while there were some statistically significant differences between patients´ perceptions of fixed and removableappliances but these differences were only minor and seemsto have minor clinical relevance. As fixed and removableappliances were generally well accepted by the patients, bothmethods of treatment can be recommended. Key conclusions and clinical implicationsFour outcome measures were evaluated: -success rate oftreatment, treatment stability, cost-effectiveness and patientacceptance, which is important from both patient and caregiver perspectives. It is concluded that both methods have highsuccess rates, demonstrate good long-term stability and are wellaccepted by the patients. Treatment by removable appliance isthe more expensive alternative. Thus, in the studies on whichthis thesis is based, fixed appliance emerges as the preferredapproach to correction of anterior crossbite with functionalshift in the mixed dentition.
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| 12. |
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| 13. |
- Wiedel, Anna-Paulina, et al.
(författare)
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Fixed versus removable orthodontic appliances to correct anterior crossbite in the mixed dentition : a randomized controlled trial
- 2015
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Ingår i: European Journal of Orthodontics. - : Oxford University Press. - 0141-5387 .- 1460-2210. ; 37:2, s. 123-127
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare the effectiveness of fixed and removable orthodontic appliances in correcting anterior crossbite with functional shift in the mixed dentition. Subjects and methods: Consecutive recruitment of 64 patients who met the following inclusion criteria: early to late mixed dentition, anterior crossbite with functional shift, moderate space deficiency in the maxilla, i.e. up to 4mm, a non-extraction treatment plan, the ANB angle > 0 degree, and no previous orthodontic treatment. Sixty-two patients agreed to participate. The study was designed as a randomized controlled trial with two parallel arms. After written consent was obtained, the patients were randomized, in blocks of 10, for treatment either with a removable appliance with protruding springs or a fixed appliance with multi-brackets. The main outcome measures assessed were success rate, duration of treatment, and changes in overjet, overbite, and arch length. The results were also analysed on an intention-to-treat basis. Results: The crossbite was successfully corrected in all patients in the fixed appliance group and all except one in the removable appliance group. The average duration of treatment was significantly less, 1.4 months, for the fixed appliance group (P < 0.05). There were significant increases in arch length and overjet in both treatment groups, but significantly more in the fixed appliance group (P < 0.05 and P < 0.01). Conclusion: Anterior crossbite with functional shift in the mixed dentition can be successfully corrected by either fixed or removable appliance therapy in a short-term perspective.
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| 14. |
- Wiedel, Anna-Paulina, et al.
(författare)
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Stability of anterior crossbite correction : a randomized controlled trial with a 2-year follow-up
- 2014
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Ingår i: Angle orthodontist. - : Angle Orthodontist. - 0003-3219 .- 1945-7103. ; 85:2, s. 189-195
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Objective: To compare and evaluate the stability of correction of anterior crossbite in the mixed dentition by fixed or removable appliance therapy. Material and Methods: The subjects were 64 consecutive patients who met the following inclusion criteria: early to late mixed dentition, anterior crossbite affecting one or more incisors, no inherent skeletal Class III discrepancy, moderate space deficiency, a nonextraction treatment plan, and no previous orthodontic treatment. The study was designed as a randomized controlled trial with two parallel arms. The patients were randomized for treatment with a removable appliance with protruding springs or with a fixed appliance with multibrackets. The outcome measures were success rates for crossbite correction, overjet, overbite, and arch length. Measurements were made on study casts before treatment (T0), at the end of the retention period (T1), and 2 years after retention (T2). Results: At T1 the anterior crossbite had been corrected in all patients in the fixed appliance group and all except one in the removable appliance group. At T2, almost all treatment results remained stable and equal in both groups. From T0 to T1, minor differences were observed between the fixed and removable appliance groups with respect to changes in overjet, overbite, and arch length measurements. These changes had no clinical implications and remained unaltered at T2. Conclusions: In the mixed dentition, anterior crossbite affecting one or more incisors can be successfully corrected by either fixed or removable appliances with similar long-term stability; thus, either type of appliance can be recommended.
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| 15. |
- Yasin, Lina, et al.
(författare)
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Long-term patient-reported outcomes after anterior distraction osteogenesis of the maxilla in patients with cleft
- 2023
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Ingår i: Journal of Plastic Surgery and Hand Surgery. - : Taylor & Francis Group. - 2000-656X .- 2000-6764. ; 57:1-6, s. 488-493
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Tidskriftsartikel (refereegranskat)abstract
- Maxillary growth inhibition in patients with cleft lip and palate (CLP) is an undesired effect that may occur in the teens despite proper primary care. Dental malocclusion and distortion of facial appearance can be treated with external distraction osteogenesis (DO) of the maxilla. This entails a Le Fort I osteotomy, fastening a semi-circular distractor to the skull, distraction for three weeks, and fixation for three months before removal of the device.The aim of this descriptive long-term follow-up study was to evaluate DO of the maxilla from the patient-reported long-term perspective.Fourteen patients underwent a long-term follow-up including a questionnaire regarding their experience of DO. Sex, CLP diagnosis, age at DO and follow-up, and time required for active distraction and fixation were noted. Furthermore, documentation on rhinoplasty, lip plasty and velopharyngeal plasty after DO was registered. Objective results were assessed by a positive dental overjet in the front.Ten patients considered the distractor an everyday constraint, but all thought the procedure was worthwhile and would recommend it to others. Thirteen patients experienced improved bite and chewing, whereas one considered function unchanged. All were satisfied with their dental alignment. Three patients underwent a velopharyngeal plasty after DO. Moreover, six rhinoplasties and two lip plasties were performed.Despite a long and challenging treatment, teenagers and young adults with CLP and maxillary hypoplasia tolerate DO of the maxilla very well. Secondary measures to improve speech and appearance are often indicated.
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