Effect of Infant Orthopedics on Facial Appearance of Toddlers with Complete Unilateral Cleft Lip and Palate (Dutchcleft)

Abstract

Objective:

To evaluate the effect of infant orthopedics (IO) on facial appearance of 54 patients with unilateral cleft lip and palate (UCLP), aged 4 and 6 years.

Design:

Prospective two-arm randomized controlled clinical trial in three Cleft Palate Centers in the Netherlands (Dutchcleft-trial).

Interventions:

Patients were divided randomly into two groups. Half of the patients (IO+) had a plate until surgical closure of the soft palate at the age of ± 52 weeks; the other half (IO−) received no intervention.

Main Outcome Measures:

Facial appearance at 4 and 6 years of age assessed on full face photographs and photographs showing only nose and mouth. Ratings were performed on a VAS-scale by professionals and laymen.

Results:

At 4 years of age the full face pictures of IO+ children were scored to be more attractive than those of IO− children. However, this difference had disappeared at 6 years of age. At the age of 6, only professionals saw a significant difference on nasolabial photographs between IO+ and IO−. Regression analysis showed a minor effect of occlusion, lip revision, or type of nose reconstruction on the esthetic results.

Conclusions:

IO had a positive effect on full facial appearance of UCLP children at the age of 4 years, but at the age of 6, only professionals saw a positive effect of IO on the nasolabial photographs. This is irrelevant for UCLP patients since they deal with laymen in their daily life.

Keywords

esthetics cleft palate treatment outcome infant orthopedics randomized clinical trial multicenter

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References

Asher-McDade

Brattström

Dahl

McWilliam

Mølsted

Plint

D.A.

Prahl-Andersen

Semb

Shaw

W.C.

The

R.P.S.

A six-center international study of treatment outcome in patients with clefts of the lip and palate: part 4. Assessment of nasolabial appearance.

Cleft Palate Craniofac J. 1992; 29: 409–412.

Asher-McDade

Roberts

Shaw

W.C.

Gallager

Development of a method for rating nasolabial appearance in patients with clefts of the lip and palate.

Cleft Palate Craniofac J. 1991; 28: 385–391.

Bongaarts

C.A.M.

Kuijpers-Jagtman

A.M.

van't Hof

M.A.

Prahl-Andersen

The effect of infant orthopedics on the occlusion of the deciduous dentition in children with complete unilateral cleft lip and palate (Dutchcleft).

Cleft Palate Craniofac J. 2004; 41: 633–641.

Bongaarts

C.A.M.

van't Hof

M.A.

Prahl-Andersen

Dirks

I.V.

Kuijpers-Jagtman

A.M.

Infant orthopedics (IO) has no effect on maxillary arch dimensions in the deciduous dentition of children with complete unilateral cleft lip and palate (Dutchcleft).

Cleft Palate Craniofac J. 2006; 43: 665–672.

Eliason

M.J.

Hardin

M.A.

Olin

W.H.

Factors that influence ratings of facial appearance for children with cleft lip and palate.

Cleft Palate Craniofac J. 1991; 28: 190–193.

Gnoinski

W.M.

Infant orthopedics and later orthodontic monitoring for unilateral cleft lip and palate patients in Zürich. In: Bardach

Morris

H.L.

, eds. Multidisciplinary Management of Cleft Lip and Palate. Philadelphia: WB Saunders; 1990: 578–585.

Graf-Pinthus

Bettex

Long-term observation following presurgical orthopedic treatment in complete clefts of the lip and palate.

Cleft Palate J. 1974; 11: 253–260.

Hotz

Gnoinski

Comprehensive care of cleft lip and palate children at Zürich University: a preliminary report.

Am J Orthod. 1976; 70: 481–504.

Howells

D.J.

Shaw

W.C.

The validity and reliability of ratings of dental and facial attractiveness for epidemiologic use.

Am J Orthod. 1985; 88: 402–408.

10.

Konst

E.M.

Prahl

Weersink-Braks

De Boo

Prahl-Andersen

Kuijpers-Jagtman

A.M.

Severens

J.L.

Cost-effectiveness of infant orthopedic treatment regarding speech in patients with complete unilateral cleft lip and palate: a randomized three-center trial in the Netherlands (Dutchcleft).

Cleft Palate Craniofac J. 2004; 41: 71–77.

11.

Konst

E.M.

Rietveld

Peters

Prahl-Andersen

Phonological development of toddlers with unilateral cleft lip and palate who were treated with and without infant orthopedics: a randomized clinical trial.

Cleft Palate Craniofac J. 2003a; 40: 32–39.

12.

Konst

E.M.

Rietveld

Peters

Kuijpers-Jagtman

A.M.

Language skills of young children with unilateral cleft lip and palate following infant orthopedics: a randomized clinical trial.

Cleft Palate Craniofac J. 2003b; 40: 356–362.

13.

Konst

E.M.

Rietveld

Peters

Weersink-Braks

Use of perceptual evaluation instrument to assess the effects of infant orthopedics on the speech of toddlers with cleft lip and palate.

Cleft Palate Craniofac J. 2003c; 40: 597–605.

14.

Konst

E.M.

Weersink-Braks

Rietveld

Peters

Prelexical development of unilateral cleft lip and palate babies with reference to presurgical infant orthopedics: a randomized prospective clinical trial.

Clin Linguist Phonet. 1999; 13: 395–407.

15.

Konst

E.M.

Weersink-Braks

Rietveld

Peters

An intelligibility assessment of toddlers with cleft lip and palate who received and did not receive presurgical infant orthodopedic treatment.

J Commun Disord. 2000; 33: 483–501.

16.

Kuijpers-Jagtman

A.M.

Prahl-Andersen

History of neonatal orthopedics: past to present. In: Berkowitz

, ed. Cleft Lip and Palate. Diagnosis and Management. Berlin and Heidelberg, Germany: Springer-Verlag; 2006: 395–407.

17.

Okkerse

J.M.E.

Beemer

F.A.

Cordia-de Haan

Heineman-de Boer

J.A.

Mellenbergh

G.J.

Wolters

W.H.G.

Facial attractiveness and facial impairment ratings in children with craniofacial malformations.

Cleft Palate Craniofac J. 2001; 38: 386–392.

18.

Peerlings

R.H.

Kuijpers-Jagtman

A.M.

Hoeksma

J.B.

A photographic scale to measure facial aesthetics.

Eur J Orthod. 1995; 17: 101–109.

19.

Prahl

Kuijpers-Jagtman

A.M.

van't Hof

M.A.

Prahl-Andersen

A randomized prospective clinical trial into the effect of infant orthopedics on maxillary arch dimensions in unilateral cleft lip and palate (Dutchcleft).

Eur J Oral Sci. 2001; 109: 297–305.

20.

Prahl

Kuijpers-Jagtman

A.M.

van't Hof

M.A.

Prahl-Andersen

A randomized prospective clinical trial into the effect of infant orthopedics in UCLP. Prevention of collapse of the alveolar segments (Dutchcleft).

Cleft Palate Craniofac J. 2003; 40: 337–342.

21.

Prahl

Kuijpers-Jagtman

A.M.

van't Hof

M.A.

Prahl-Andersen

Infant orthopedics in UCLP: effect on feeding, weight and length: a randomized clinical trial (Dutchcleft).

Cleft Palate Craniofac J. 2005; 42: 171–177.

22.

Prahl

Kuijpers-Jagtman

A.M.

van't Hof

M.A.

Prahl-Andersen

Infant orthopedics and facial appearance. A randomized clinical trial (Dutchcleft).

Cleft Palate Craniofac J. 2006; 43: 659–664.

23.

Ross

R.B.

Treatment variables affecting facial growth in complete unilateral cleft lip and palate.

Cleft Palate J. 1987; 24: 5–77.

24.

Tedesco

L.A.

Albino

J.E.

Cunat

J.J.

Green

L.J.

Lewis

E.A.

Slakter

M.J.

A dental-facial attractiveness scale. Part I. Reliability and validity.

Am J Orthod. 1983; 83: 38–43.

25.

Tobiasen

J.M.

Social judgments of facial deformity.

Cleft Palate J. 1987; 24: 323–327.

26.

Tobiasen

J.M.

Scaling facial impairment.

Cleft Palate J. 1989; 26: 249–254.

27.

Tobiasen

J.M.

Hiebert

J.M.

Boraz

R.A.

Development of scales of severity of facial cleft impairment.

Cleft Palate Craniofac J. 1991; 28: 419–424.

28.

Winters

J.C.

Hurwitz

D.J.

Presurgical orthopedics in the surgical management of unilateral cleft lip and palate.

Plast Reconstr Surg. 1995; 95: 755–764.