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Cleft Lip and Palate: Current Treatment and Future Options
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Cleft Lip and Palate: Current Treatment and Future Options

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Dentistry, Oral Surgery and Oral Medicine".

Deadline for manuscript submissions: 25 January 2025 | Viewed by 6668

Special Issue Editor

Dr. Rami S. Kantar

E-Mail Website
Guest Editor
The Hansjörg Wyss Department of Plastic Surgery, New York University, New York City, NY, USA
Interests: cleft surgery; craniofacial surgery; plastic surgery; reconstructive surgery; global surgery; global health

Special Issue Information

Dear Colleagues,

Orofacial clefts are estimated to affect 1 in every 700 live births on average, with significant global variations in incidence and prevalence. Evolution in the treatment of cleft lips and/or palates has resulted in improved functional and aesthetic outcomes for affected patients. Nevertheless, it is well established that patients who do not receive appropriate or timely cleft care are at significantly increased risk for lifelong morbidity and sequelae resulting from the condition. With improved understanding of surgical anatomy, perioperative factors impacting patient outcomes, the importance of multidisciplinary treatment and access to care, cleft surgery education, and surgical technological advancements, the field is currently poised to refine and further optimize care for patients affected with clefts of the lip and/or palate more than ever. In this Special Issue, we welcome authors to submit manuscripts that address the current treatment of clefts of the lip and/or palate, as well as future directions in the field.  

Dr. Rami S. Kantar
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cleft
  • cleft lip
  • cleft palate
  • cleft surgery
  • lip
  • palate
  • plastic surgery
  • reconstructive surgery
  • craniofacial surgery

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Published Papers (7 papers)

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9 pages, 1570 KiB  
Article
Comparison of the Effects of Postoperative Arm Restraints and Mittens on Cleft Lip Scar Quality after Primary Repair
by Alexandra N. Verzella, Matteo Laspro, Allison Diaz, Michael F. Cassidy, Jenn Park, Jill Schechter, Andre Alcon, Pradip R. Shetye, David A. Staffenberg and Roberto L. Flores
J. Clin. Med. 2024, 13(13), 3619; https://doi.org/10.3390/jcm13133619 - 21 Jun 2024
Viewed by 595
Abstract
Introduction: Postoperative management following primary cleft lip repair varies across institutions, cleft care teams, and individual surgeons. Postoperative precautions employed after cleft lip repair include dietary restrictions, pacifier limitations, and immobilization, with arm restraints long being used. Yet, restraint distress has led [...] Read more.
Introduction: Postoperative management following primary cleft lip repair varies across institutions, cleft care teams, and individual surgeons. Postoperative precautions employed after cleft lip repair include dietary restrictions, pacifier limitations, and immobilization, with arm restraints long being used. Yet, restraint distress has led to the exploration of other forms of immobilization. Thus, this study aims to assess cleft lip scar quality and complication rates after postoperative immobilization with arm restraints versus hand mittens. Methods: A retrospective review of patients with unilateral cleft who underwent primary repair with the senior surgeon was done. Data on demographics, surgical characteristics, and immobilization utilized were gathered. A survey with pictures of postoperative scars were sent to laypeople who assessed scar quality with Modified Scar-Rating Scale scores for surface appearance, height, and color of the scar tissue. Statistical analysis was carried out for significance. Results: Twenty-eight patients with a unilateral cleft underwent arm restraints after primary lip repair, and twenty-seven utilized mittens. In total, 42 medical students completed the scar assessment. Photographs were taken an average of 23.9 (±5.8) and 28.2 (±11.9) months postoperatively in the restraint and mitten groups, respectively (p = 0.239). There were no statistically significant differences in scores between scar surface, height, color, or overall scar appearance. Complication rates were also similar between groups. Conclusions: Arm restraints appear to have no additional benefit relative to scar quality, as compared to mittens. Considering the arm restraints’ burden of care, mittens should be considered as a measure to protect the lip after primary repair. Full article
(This article belongs to the Special Issue Cleft Lip and Palate: Current Treatment and Future Options)
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12 pages, 1503 KiB  
Article
Contemporary Prevalence of Oral Clefts in the US: Geographic and Socioeconomic Considerations
by Hilliard T. Brydges, Matteo Laspro, Alexandra N. Verzella, Andre Alcon, Jill Schechter, Michael F. Cassidy, Bachar F. Chaya, Eduardo Iturrate and Roberto L. Flores
J. Clin. Med. 2024, 13(9), 2570; https://doi.org/10.3390/jcm13092570 - 27 Apr 2024
Viewed by 1269
Abstract
Background: Socio-economic status, living environments, and race have been implicated in the development of different congenital abnormalities. As orofacial clefting is the most common anomaly affecting the face, an understanding of its prevalence in the United States and its relationship with different determinants [...] Read more.
Background: Socio-economic status, living environments, and race have been implicated in the development of different congenital abnormalities. As orofacial clefting is the most common anomaly affecting the face, an understanding of its prevalence in the United States and its relationship with different determinants of health is paramount. Therefore, the purpose of this study is to determine the modern prevalence of oral–facial clefting in the United States and its association with different social determinants of health. Methods: Utilizing Epic Cosmos, data from approximately 180 US institutions were queried. Patients born between November 2012 and November 2022 were included. Eight orofacial clefting (OC) cohorts were identified. The Social Vulnerability Index (SVI) was used to assess social determinants of health. Results: Of the 15,697,366 patients identified, 31,216 were diagnosed with OC, resulting in a prevalence of 19.9 (95% CI: 19.7–20.1) per 10,000 live births. OC prevalence was highest among Asian (27.5 CI: 26.2–28.8) and Native American (32.8 CI: 30.4–35.2) patients and lowest among Black patients (12.96 CI: 12.5–13.4). Male and Hispanic patients exhibited higher OC prevalence than female and non-Hispanic patients. No significant differences were found among metropolitan (20.23/10,000), micropolitan (20.18/10,000), and rural populations (20.02/10,000). SVI data demonstrated that OC prevalence was positively associated with the percentage of the population below the poverty line and negatively associated with the proportion of minority language speakers. Conclusions: This study examined the largest US cohort of OC patients to date to define contemporary US prevalence, reporting a marginally higher rate than previous estimates. Multiple social determinants of health were found to be associated with OC prevalence, underscoring the importance of holistic prenatal care. These data may inform clinicians about screening and counseling of expectant families based on socio-economic factors and direct future research as it identifies potential risk factors and provides prevalence data, both of which are useful in addressing common questions related to screening and counseling. Full article
(This article belongs to the Special Issue Cleft Lip and Palate: Current Treatment and Future Options)
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20 pages, 6636 KiB  
Article
What We Learned from Performing the Inverse Malek Procedure to Repair Bilateral Cleft Lips and Palates: A Single-Center Retrospective Study
by Karim Al-Dourobi, Tessa Mermod, Marie-Thérèse Doan, Georges Herzog, Martin Broome, Oumama El Ezzi and Anthony de Buys Roessingh
J. Clin. Med. 2024, 13(7), 1939; https://doi.org/10.3390/jcm13071939 - 27 Mar 2024
Viewed by 851
Abstract
Background: This study reviews the surgical and functional outcomes of children diagnosed with a bilateral cleft lip and palate and treated by the same surgical team following specific surgical protocols 18 years after surgery and during the follow-up. Methods: Based on [...] Read more.
Background: This study reviews the surgical and functional outcomes of children diagnosed with a bilateral cleft lip and palate and treated by the same surgical team following specific surgical protocols 18 years after surgery and during the follow-up. Methods: Based on a single-center retrospective design, demographic and surgical data were gathered by the authors from international institutions. Most of the data were quantitative in nature, and descriptive statistical and non-parametric tests were employed for analysis. All children born with a bilateral cleft from 1982 to 2002 were considered. Children affected by a syndrome were excluded. Complications and speech results were the main items measured. Results: Thirty patients were selected; 73.3% were treated using the inverse Malek procedure, and 26.7% underwent a modified two-stage procedure. Seventy percent developed an oronasal fistula. An alveolar bone graft was performed in 83%, and 53.3% underwent Le Fort osteotomy. Thirty-six percent required a pharyngeal flap, with good speech results. The median number of times general anesthesia was used among all the interventions considered was 5.5 (4.25–6). Conclusions: This study presents the long-term results of using the inverse Malek procedure to treat children with a bilateral cleft lip and palate. It is shown that this is related to a high risk of developing a fistula, but has good long-term speech results. Full article
(This article belongs to the Special Issue Cleft Lip and Palate: Current Treatment and Future Options)
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12 pages, 3581 KiB  
Article
The Use of Clear Aligners in Multi-Segmental Maxillary Surgery: A Case–Control Study in Cleft Lip and Palate and Skeletal Class III Patients
by Maria Costanza Meazzini, Leonardo Paolo Demonte, Noah Cohen, Valeria Marinella Augusta Battista, Dimitri Rabbiosi and Luca Autelitano
J. Clin. Med. 2024, 13(5), 1329; https://doi.org/10.3390/jcm13051329 - 26 Feb 2024
Viewed by 963
Abstract
Background: Maxillary hypoplasia and mandibular asymmetry may be corrected with orthognathic surgery after growth completion. For most stable results, some cases may require segmental Le Fort I osteotomies. Unfortunately, Invisalign’s software (6.0 version) still has some inherent limitations in predicting outcomes for [...] Read more.
Background: Maxillary hypoplasia and mandibular asymmetry may be corrected with orthognathic surgery after growth completion. For most stable results, some cases may require segmental Le Fort I osteotomies. Unfortunately, Invisalign’s software (6.0 version) still has some inherent limitations in predicting outcomes for complex surgeries. This study explores the potential of aligners, particularly in multiple-piece maxillary osteotomies in both cleft and non-cleft patients. Method: Thirteen patients who underwent pre-surgical treatment with Invisalign were retrospectively matched in terms of diagnosis, surgical procedure, and orthodontic complexity with thirteen patients treated using fixed appliances. Virtual curves following the lower arch were employed to guide the correct pre-surgical positions of the upper teeth with a simple superimposition technique. The amount of impressions required in both groups to achieve satisfactory pre-surgical alignment of the segmented arches was compared. Results: one or no refinement phases were needed in the Invisalign group to reach an acceptable pre-surgical occlusion, while the amount of pre-surgical impressions needed to reach adequate coordination with fixed appliance treatment was slightly higher (p > 0.05). Conclusions: it appears that clear aligner could serve as an effective treatment for individuals necessitating segmental Le Fort I osteotomies when aided by the suggested simple superimposition approach. Full article
(This article belongs to the Special Issue Cleft Lip and Palate: Current Treatment and Future Options)
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9 pages, 722 KiB  
Systematic Review
The Use of Stem Cells in Bone Regeneration of Cleft Lip and Palate Patients: A Systematic Review
by Mohamed Jaber, Aalaa Majed Alshikh Ali, Roba Imad El Saleh and Prathibha Prasad
J. Clin. Med. 2024, 13(17), 5315; https://doi.org/10.3390/jcm13175315 - 8 Sep 2024
Viewed by 479
Abstract
Background and Objectives: Cleft lip alone or a combination of cleft lip and palate (CLP) is a common developmental abnormality in the craniofacial region. This umbrella review aims to identify promising avenues for treatment using stem cell therapy. Materials and Methods: Systematic reviews [...] Read more.
Background and Objectives: Cleft lip alone or a combination of cleft lip and palate (CLP) is a common developmental abnormality in the craniofacial region. This umbrella review aims to identify promising avenues for treatment using stem cell therapy. Materials and Methods: Systematic reviews from 2014 to 2024 were searched among databases like PubMed, Medline, and Google Scholar. PRISMA guidelines were employed to ensure the thoroughness of the search. A quality assessment (ROBIS) of the included reviews was conducted to ensure the reliability and validity of the synthesized evidence. Results: Five systematic reviews were selected for this umbrella review. Results show that stem cell therapy, specifically using mesenchymal stem cells (MSCs) and adipocyte stem cells (ADSCs), promotes bone regeneration in CLP deformities. Although multiple studies have established the effectiveness of diverse types of stem cells in treating CLP, important considerations including safety concerns, methodological variability, and the need for standardization have been identified. The fact that the number of relevant systematic reviews that matched our inclusion criteria was limited could affect this research’s robustness and may limit the breadth and depth of evidence synthesis. Definitive conclusions could not be reached due to variation among treatments and outcomes. Conclusions: The examined studies highlight the potential of stem cell therapy as a complementary approach to existing treatments for CLP. However, there are challenges that need to be addressed, including concerns regarding safety, variations in methodologies, and the need for standardization. Exploring the potential of other stem cell types may further enhance treatment outcomes for CLP patients. Full article
(This article belongs to the Special Issue Cleft Lip and Palate: Current Treatment and Future Options)
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10 pages, 5359 KiB  
Case Report
Floating–Harbor Syndrome: A Systematic Literature Review and Case Report
by Wojciech Dobrzynski, Julia Stawinska-Dudek, Natalia Moryto, Dominika Lipka and Marcin Mikulewicz
J. Clin. Med. 2024, 13(12), 3435; https://doi.org/10.3390/jcm13123435 - 12 Jun 2024
Viewed by 859
Abstract
Floating–Harbor syndrome (FHS) is an extremely rare genetic disorder connected with a distinctive facial appearance, various skeletal malformations, delayed bone age, and expressive language delays. It is caused by heterozygous mutations in the Snf2-related CREBBP activator protein (SRCAP) gene. The aim of this [...] Read more.
Floating–Harbor syndrome (FHS) is an extremely rare genetic disorder connected with a distinctive facial appearance, various skeletal malformations, delayed bone age, and expressive language delays. It is caused by heterozygous mutations in the Snf2-related CREBBP activator protein (SRCAP) gene. The aim of this paper is to describe the case of a 14-year-old male with FHS, referring to a review of the literature, and to collect all reported symptoms. In addition, the orthodontic treatment of the patient is described. For this, the electronic databases PubMed and Scopus were searched using the keyword “Floating–Harbor syndrome”. Similar to previous cases in the literature, the patient presented with short stature; a triangular face with a large bulbous nose; deep-set eyes and narrow eyelid gaps; a wide mouth with a thin vermilion border of the upper lip; and dorsally rotated, small ears. They also presented some less-described symptoms, such as macrodontia and micrognathia. Moreover, mild mental retardation, microcephaly, and delayed psychomotor development were found. On the basis of an extraoral, intraoral examination, X-rays, and CBCT, he was diagnosed with overbite, canine class I and angle class III, on both sides. To the best of our knowledge, orthodontic treatment of this disease has not been assessed in detail so far, so this is the first case. Full article
(This article belongs to the Special Issue Cleft Lip and Palate: Current Treatment and Future Options)
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17 pages, 7046 KiB  
Technical Note
Single-Stage Posterior Vomerine Ostectomy, Premaxillary Setback, Bilateral Gingivoperiosteoplasties and Primary Bilateral Cheiloplasty in Patients with Protuberant Premaxilla
by Usama S. Hamdan, Jose A. Garcia Garcia, Mario S. Haddad, Robert A. Younan, Antonio M. Melhem, Rami S. Kantar and Wassim W. Najjar
J. Clin. Med. 2024, 13(9), 2609; https://doi.org/10.3390/jcm13092609 - 29 Apr 2024
Viewed by 895
Abstract
Various patients with complete bilateral cleft lip and palate present with a protruded premaxilla. Several techniques have been described for correctional repair of the projection with a plethora of unsatisfactory outcomes. This poses a challenge not only for the cleft team providing care [...] Read more.
Various patients with complete bilateral cleft lip and palate present with a protruded premaxilla. Several techniques have been described for correctional repair of the projection with a plethora of unsatisfactory outcomes. This poses a challenge not only for the cleft team providing care but also for the patients and their respective families. Multiple patients suffer from residual deformities after inadequate primary repair, which increase surgical, financial, and psychological burden. Premaxillary setback with posterior vomerine ostectomy and complete bilateral cleft lip repair can promote alignment of the premaxilla with the maxillary prominences. To effectively address this challenging deformity, we describe a single-stage surgical technique that includes vomerine ostectomy posterior to the vomero–premaxillary suture, bilateral gingivoperiosteoplasties with complete bilateral cleft lip repair, and primary cleft rhinoplasty. Careful surgical planning is essential for adequate matching between the length of the protruded premaxilla and the extent of ostectomy. The described technique offers several advantages for the management of complete bilateral cleft lip with a projected premaxilla. It can be applied anywhere around the world and is most beneficial in underprivileged areas where patients suffer from restricted access to healthcare, absence of presurgical orthodontics and lack of sufficient resources. Full article
(This article belongs to the Special Issue Cleft Lip and Palate: Current Treatment and Future Options)
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