| 1. |
- Semb, Gunvor, et al.
(författare)
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A Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 1. Planning and management.
- 2017
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Ingår i: Journal of Plastic Surgery and Hand Surgery. - : Taylor & Francis. - 2000-656X .- 2000-6764. ; 51:1, s. 2-13
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND AIMS: Longstanding uncertainty surrounds the selection of surgical protocols for the closure of unilateral cleft lip and palate, and randomised trials have only rarely been performed. This paper is an introduction to three randomised trials of primary surgery for children born with complete unilateral cleft lip and palate (UCLP). It presents the protocol developed for the trials in CONSORT format, and describes the management structure that was developed to achieve the long-term engagement and commitment required to complete the project.METHOD: Ten established national or regional cleft centres participated. Lip and soft palate closure at 3-4 months, and hard palate closure at 12 months served as a common method in each trial. Trial 1 compared this with hard palate closure at 36 months. Trial 2 compared it with lip closure at 3-4 months and hard and soft palate closure at 12 months. Trial 3 compared it with lip and hard palate closure at 3-4 months and soft palate closure at 12 months. The primary outcomes were speech and dentofacial development, with a series of perioperative and longer-term secondary outcomes.RESULTS: Recruitment of 448 infants took place over a 9-year period, with 99.8% subsequent retention at 5 years.CONCLUSION: The series of reports that follow this introductory paper include comparisons at age 5 of surgical outcomes, speech outcomes, measures of dentofacial development and appearance, and parental satisfaction. The outcomes recorded and the numbers analysed for each outcome and time point are described in the series.TRIAL REGISTRATION: ISRCTN29932826.
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| 2. |
- Berkowitz, Samuel, et al.
(författare)
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Timing of cleft palate closure should be based on the ratio of the area of the cleft to that of the palatal segments and not on age alone.
- 2005
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Ingår i: Plastic and reconstructive surgery. - 1529-4242. ; 115:6, s. 1483-99
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Retrospective and prospective serial spatiotemporal investigations were carried out primarily to determine whether the ratio of the size of the posterior cleft space relative to the palatal surface area limited laterally by the alveolar ridges can be used to select the appropriate time for surgical closure of the palatal cleft space. Two subsamples were compared to determine whether the size of the palate and velocity of palatal development in well growing cases differ from those in cases treated by vomer flap surgery. The prospective investigation asked whether presurgical orthopedics increases the rate of palatal growth and palatal size. METHODS: Using the palatal casts of 242 male and female individuals from eight institutions in the United States and Western Europe that followed a variety of treatment protocols, separate serial analyses were conducted of well growing cases with excellent aesthetics, dental occlusion, and speech and a control series of 17 cases of various clefts of the lip and alveolus and/or soft palate but no clefts in the hard palate. Twelve groupings of cases were established depending on their institutional location and type of cleft. RESULTS: Among the various institutions in the study, palatal growth rates and size were statistically similar. Growth in the various clinical series (size, mm2) was less than that of the control series. The ratio of cleft space size to palatal surface area medial to the alveolar ridges was 10 percent or less at 18 months of age in most cases. There was no statistical difference in total surface size between groups, except for one series whose total growth size was least of all. Right and left lateral palatal segments, whether large or small, grew at the same rate. The sample of bilateral cases was too small for statistical comparisons. Presurgical orthopedics did not stimulate palatal growth. The coefficient of variance was less than 10 percent in all measurements. CONCLUSIONS: Delaying all cleft closure surgery until 5 years of age and older is unnecessary to maximize palatal growth. The best time to close the palatal cleft space is when the palatal cleft size is 10 percent or less of the total palatal surface area bounded laterally by the alveolar ridges. The 10 percent ratio generally occurs between 18 and 24 months but can occur earlier or later. There is more than one good type of palatal cleft closure surgery.
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| 3. |
- Cardeña, Etzel, et al.
(författare)
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Letter to the editor.
- 2007
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Ingår i: Monitor on Psychology. - : SAGE Publications. - 1529-4978. ; 44:4, s. 456-457
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Tidskriftsartikel (refereegranskat)
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| 4. |
- Figueroa, Alvaro A, et al.
(författare)
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Long-term skeletal stability after maxillary advancement with distraction osteogenesis using a rigid external distraction device in cleft maxillary deformities.
- 2004
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Ingår i: Plastic and reconstructive surgery. - 1529-4242. ; 114:6
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Tidskriftsartikel (refereegranskat)abstract
- Rigid external distraction is a highly effective technique for correction of maxillary hypoplasia in patients with orofacial clefts. The clinical results after correction of sagittal maxillary deformities in both the adult and pediatric age groups have been stable. The purpose of this retrospective longitudinal cephalometric study was to review the long-term stability of the repositioned maxilla in cleft patients who underwent maxillary advancement with rigid external distraction. Between April 1, 1995, and April 1, 1999, 17 consecutive patients with cleft maxillary hypoplasia underwent maxillary advancement using rigid external distraction. There were 13 male patients and four female patients, with ages ranging from 5.2 to 23.6 years (mean, 12.6 years). After a modified complete high Le Fort I osteotomy and a latency period of 3 to 5 days, patients underwent maxillary advancement with rigid external distraction until proper facial convexity and dental overjet and overbite were obtained. After active distraction, a 3- to 4-week period of rigid retention was undertaken; this was followed by removable elastic retention for 6 to 8 weeks using, during sleep time, an orthodontic protraction face mask. Cephalometric radiographs were obtained preoperatively, after distraction, at 1 year after distraction, and 2 or more years after distraction. The mean follow-up was 3.3 years (minimum, 2.1 years; maximum, 5.3 years). The following measurements were obtained in each cephalogram: three linear horizontal and two linear vertical maxillary measurements, two angular craniomaxillary measurements, and one craniomandibular measurement. Differences between the preoperative and postoperative cephalometric values were analyzed by paired t tests (p < 0.05). The cephalometric analysis demonstrated postoperatively significant advancement of the maxilla. In addition, the mandibular plane angle opened 1.2 degrees after surgery. After the 1- to 3-year follow-up period, the maxilla was stable in the sagittal plane. Minimal anteroposterior growth was observed in the maxilla compared with that exhibited in the anterior cranial base. However, there was significant vertical maxillary growth over the 3-year observation period. The mandibular plane angle tended to decrease during the follow-up period. The cephalometric data from this study support the clinical impression of maxillary stability after maxillary advancement with rigid external distraction in cleft patients. This effective and stable technique is now considered for all pediatric patients with severe cleft maxillary hypoplasia and for adolescent and adult patients with moderate to severe deformities.
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| 5. |
- Friede, Hans, 1938, et al.
(författare)
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Letter to the Editor.
- 2012
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Ingår i: The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association. - : SAGE Publications. - 1545-1569. ; 49:4, s. 512-513
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
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| 6. |
- Friede, Hans, 1938, et al.
(författare)
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Long-Term, Longitudinal Follow-Up of Individuals with UCLP After the Gothenburg Primary Early Veloplasty and Delayed Hard Palate Closure Protocol: Maxillofacial Growth Outcome.
- 2012
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Ingår i: The Cleft Palate-Craniofacial Journal. - : SAGE Publications. - 1545-1569 .- 1055-6656. ; 49:6, s. 649-656
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Objective: To study long-term maxillofacial development in a sample of patients born with unilateral cleft lip and palate (UCLP). The patients' palatal repair had been performed according to a two-stage protocol with early velar closure and delayed hard palate surgery. Design: Retrospective longitudinal cohort study. Subjects: The sample consisted of 50 consecutive patients with UCLP born from 1980 to 1989. All of them had been operated on at the Sahlgrenska University Hospital in Gothenburg, Sweden. Methods: Certain maxillary casts as well as lateral roentgencephalograms, obtained at 5; 10; 16; and 19 years of age, were analyzed. Results: Our patients' maxillofacial growth was very good even up to the final examination at early adulthood. We ascribe the advantageous midfacial morphology of our patients particularly to limited growth restriction from palatal scars due to the surgical protocol used in our cleft center. Conclusion: The two-stage protocol advocated by us for repair of the palatal cleft resulted in very satisfactory growth outcome. A palatal scar, that might impair maxillary development, was created only by the velar surgery. If this scar was located close to the posterior border of the hard palate, it might result in less maxillary growth restriction than if it was positioned further anteriorly. Key Words: Cephalometrics, cleft lip and palate, delayed hard palate repair, growth, maxilla, surgery.
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| 7. |
- Friede, Hans, 1938, et al.
(författare)
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Maxillary dental arch and occlusion in patients with unilateral cleft lip and palate treated with different delays in closure of the hard palate after early velar repair.
- 2006
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Ingår i: Scandinavian journal of plastic and reconstructive surgery and hand surgery / Nordisk plastikkirurgisk forening [and] Nordisk klubb for handkirurgi. - : Informa UK Limited. - 0284-4311. ; 40:5, s. 261-6
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Tidskriftsartikel (refereegranskat)abstract
- We wanted to find out if growth of the maxilla in 26 patients with unilateral cleft lip and palate (UCLP) was adversely affected by having the residual cleft of the hard palate repaired earlier than had been done previously in a 2-stage palatal closure protocol. The ages at repair of the hard palate of the present patients ranged from 38 to 89 months. Dental casts from ages about 3 years (before any repair of the hard palate), 5, 7, and 10 years of age were analysed. The results indicated that earlier repair of the cleft in the hard palate did not influence maxillary growth differently from the later repair.
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| 8. |
- Friede, Hans, 1938
(författare)
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Maxillary growth controversies after two-stage palatal repair with delayed hard palate closure in unilateral cleft lip and palate patients: perspectives from literature and personal experience.
- 2007
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Ingår i: The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association. - : SAGE Publications. - 1055-6656. ; 44:2, s. 129-36
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To analyze published papers dealing with delayed hard palate repair within a two-stage palatal surgery protocol in treatment of cleft lip and palate. Timing of the procedures, methods used, as well as growth results were considered. METHOD: By utilizing this information in relation to knowledge about normal maxillary development, efforts were made to explain differences in growth outcome between different investigations. Particularly, follow-up reports of unilateral cleft lip and palate patients with records up to at least 10 years of age were studied. RESULTS: Most papers reported an excellent or very good maxillary growth outcome after their delayed hard palate closure protocols. Where unsatisfactory results were published, reasonable explanations were found accounting for why the method had failed the expectation of good maxillary growth. CONCLUSION: Based on the published reports and the experience from a cleft team where the studied protocol has been practiced since 1975, recommendation for method as well as timing for the two-stage protocol is laid out in some detail.
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| 9. |
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| 10. |
- Friede, Hans, 1938
(författare)
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Two-stage palatal repair (Chapter 26)
- 2009
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Ingår i: Comprehensive Cleft Care (eds: Losee JE, Kirschner RE). - 9780071481809 ; , s. 413-429
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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