Facial attractiveness of patients with unilateral cleft lip and palate and of controls assessed by laypersons and professionals

SUMMARYOBJECTIVES: The aim of the study was to identify differences in the aesthetic evaluation of profile and frontal photographs of (1) patients treated for complete left-sided cleft lip and palate and (2) control patients by laypeople and professionals. MATERIALS, SUBJECTS, AND METHODS: Left-side profile and frontal photographs of 20 adult patients treated for complete left-sided cleft lip and palate (10 men, 10 women, mean age: 20.5 years) and of 10 control patients with a class I occlusion (five men, five women, mean age: 22.1 years) were included in the study. The post-treatment photographs were evaluated by 15 adult laypeople, 14 orthodontists, and 10 maxillofacial surgeons. Each photograph was judged on a modified visual analogue scale (VAS, 0-10; 0 ‘very unattractive' to 10 ‘very attractive'). A four-level mixed model was fitted in which the VAS score was the dependent variable; cases, profession, view, and rater were independent variables. RESULTS: Compared with laypersons, orthodontists gave higher VAS scores (+0.69, 95% confidence interval (CI) [0.53, 0.84]; P < 0.001), followed by surgeons (+0.21, 95% CI [0.03, 0.38], P = 0.02). Controls were given significantly higher scores than patients with clefts for profile and frontal photographs (+1.97, 95% CI [1.60; 2.35], P < 0.001). No significant difference was found between the scores for the frontal and lateral views (P = 0.46). CONCLUSIONS: All the different rater panels were less satisfied with the facial aesthetics of patients with clefts compared with that of control patients. Further research should evaluate whether these findings correlate with patients' self-perception and to what extent it affects the patients' psychosocial well-bein

Dominant vererbte Unterlippenfisteln und Gesichtsspalten (Van-der-Woude-Syn drom). Eine Studie an 52 Fällen

Angeborene Unterlippenfisteln können alleine oder in Kombination mit Lippen-Kiefer-Gaumen-Spalten vorkommen. Charakteristisch sind paarige Fisteln, die ins Lippenrot der Unterlippe, nahe dem Übergang von Haut zu Schleimhaut, etwa 0,5 cm von der Mittellinie entfernt, münden. In der Tiefe sind die Fisteln meist mit heterotopem Speicheldrüsengewebe verbunden; eine zeitweise Sekretion kann vorkommen. Angeborene Unterlippenfisteln sind in etwa 500/o assoziiert mit Spaltbildungen der Oberlippe, des Oberkiefers, des weichen und/oder harten Gaumens, wesentlich seltener mit fehlenden Zahnanlagen. Dieser Symptomenkomplex kommt bei verschiedenen, dominant vererbten Syndromen vor, hauptsächlich beim Van-der-Woude-Syndrom, selten beim poplitealen Pterygium-Syndrom. Beide Syndrome werden autosomal dominant vererbt. Die vorliegende Studie berichtet über 52 Träger des Van-der-Woude-Gens. Bei 8 Patienten erschien die Symptomatik als Neumutation, die restlichen 44 Fälle sind in 5 Familien aufgetreten. Die Penetranz des Gens war vollständig, die Expressivität sehr variabel. Die Geschlechtsverteilung zeigte ein Verhältnis von 1 zu 1. Daraus ergibt sich für die genetische Beratung, dass alle Träger des Van-der-Woude-Gens identifiziert werden können. Jedes Symptom (Fisteln, Mikroformen von Fisteln, Spalten, submuköse Spalten, Uvula bifida, fehlende Zahnanlagen) kann die alleinige Manifestation des Gens darstellen. Congenital lip pits may occur alone or in combination with oral clefts. They characteristically present as symmetric pits close to the vermilion border of the lower lip, about 0.5 cm off the midline, and are usually connected with heterotopic salivary glands; occasionally, salivation may occur. Congenital lip pits are associated with clefts of the upper lip and/or the palate in about half of the cases. Hypodontia may also be observed. Lip pits with or without clefts are found in a few dominantly inherited syndromes, in most cases involving the autosomal dominant Van der Woude syndrome. 52 carriers of the Van der Woude gene are described. In 8 cases the syndrome occurred as a fresh mutation and the other 44 cases occurred in 5 families. Penetrance was complete and expression very variable. Sex distribution was 1:1. For genetic counselling purposes it can be concluded that all carriers of the Van der Woude gene can be identified. Every symptom (pits, micro-pits, cleft, submucous clefts, uvula bifida) may represent the only manifestation of the gene. The recurrence risks for offspring of gene carriers is 50%, but the risk of severe forms of cleft is much lower

Die zahnärztliche Betreuung von Schwangeren - Zehn Fragen und Antworten

Dental care of pregnant patients is a demanding task. On one hand, clinicians are facing patients with an altered physiology that may cause a greater need for treatment. On the other hand, pregnancy in itself as well as the unborn child involves potential contraindications to dental interventions. It is therefore essential that dentists be knowledgeable of the ramifications pregnancy has on medical findings and therapy. Also, clinicians must be able to conduct their treatment based on well-grounded data to avoid any harm to the pregnant woman and her unborn child. This article focuses on facts specifically relevant to clinicians. Based on most current scientific data, we aim to answer the following ten questions: 1. What are the physiological changes during pregnancy? 2. What is the adequate lying position for a pregnant patient? 3. Is there a pregnancy-related gingivitis? 4. What is the association between periodontitis, pregnancy and preterm birth? 5. Are there oral manifestations of pregnancy-related therapies? 6. Are caries and erosions inevitable during pregnancy? 7. Should the intake of fluoride be advocated? 8. Is it permissible to x-ray pregnant patients? 9. Is orthodontics contraindicated during pregnancy and 10. Which medication should be administered with caution

A longitudinal cephalometric study from age 5 to 18 years on individuals with complete bilateral cleft lip and palate

Development of the facial profile between age 5 and the end of pubertal growth in patients with complete bilateral cleft lip and palate was studied by means of cephalometric x-rays taken at the age of 5, 10 and 15 years as well as at the end of the growth period. All 29 patients had been treated according to the same plan and operated upon by the same surgeon. Values for the ANB angle are typically very high in 5 year old children, and then decrease to values corresponding to those of the general population by the end of the pubertal growth period. Vertical development maintains the initial pattern; no compensatory vertical excess was observed. Due to the wide range in all measurements, the value of age-related mean values in a patient sample is of little consequence for individuals but can point out tendencies. The multidisciplinary concept of maintaining the initially protrusive position of the premaxilla by means of a passive plate at the newborn and infant stage, as well as using surgical procedures with limited retrusive effect proved to be correct in the long run: At the young adult stage the angle ANB remained positive for almost all patients except for those with multiple tooth agenesis in the upper arch. A potential benefit of two-stage palate repair is seen in the neutral vertical development of the patients examined. This hypothesis is supported by comparison with other studies from the literature