RESUMO Objetivo: o objetivo desse estudo foi avaliar a estética do perfil facial de crianças com fissura labiopalatina completa bilateral (FLCB) operadas, comparando o julgamento de leigos e de profissionais relacionados e não relacionados à reabilitação de fissuras. Métodos: fotografias do perfil facial de trinta crianças na dentadura mista (24 do sexo masculino e 6 do sexo feminino), com idade média de 7,8 anos, foram avaliadas por 25 examinadores: 5 ortodontistas e 5 cirurgiões plásticos com experiência em fissuras, 5 ortodontistas e 5 cirurgiões plásticos sem experiência na reabilitação de fissuras, e 5 leigos com formação superior. Os perfis faciais foram classificados como esteticamente desagradável (grau 1 a 3), esteticamente aceitável (grau 4 a 6) e esteticamente agradável (grau 7 a 9). Para verificar a concordância intraexaminadores e interexaminadores, foram utilizados o Coeficiente de Correlação de Spearman e o Coeficiente de Concordância de Kendall, respectivamente. Para comparação entre as categorias de acordo com os escores atribuídos, foram aplicados o teste de Friedman e o teste de Student-Newman-Keuls, para comparações múltiplas. Resultados: os ortodontistas que lidam com reabilitação de fissuras labiopalatinas consideraram a maioria da amostra como esteticamente agradável. Cirurgiões plásticos com experiência em fissuras e leigos classificaram a maioria da amostra como esteticamente aceitável. Grande parte dos ortodontistas e cirurgiões plásticos sem experiência na reabilitação de fissuras classificou o perfil facial como esteticamente desagradável. As estruturas associadas aos perfis desagradáveis foram o nariz, o terço médio da face e o lábio superior. Conclusões: o perfil facial de crianças com FLCB foi classificado como esteticamente aceitável pelos leigos; já os profissionais relacionados à reabilitação de fissuras foram mais complacentes, em comparação aos profissionais sem experiência na reabilitação de fissuras, que, por sua vez, foram mais rigorosos quanto à estética facial do que os leigos.

ABSTRACT Objective: The aim of this study was to evaluate the facial profile esthetics of rehabilitated children with complete bilateral cleft lip and palate (BCLP), comparing the judgment of professionals related and not related to cleft rehabilitation and laypersons. Methods: Thirty children in the mixed dentition (24 male; 6 female) with a mean age of 7.8 years were evaluated using facial profile photographs by 25 examiners: 5 orthodontists and 5 plastic surgeons with experience in cleft care, 5 orthodontists and 5 plastic surgeons without experience in oral cleft rehabilitation and 5 graduated laymen. Their facial profiles were classified into esthetically unpleasant (grade 1 to 3), esthetically acceptable (grade 4 to 6), and esthetically pleasant (grade 7 to 9). Intraexaminer and interexaminer errors were evaluated using Spearman correlation coefficient and Kendall’s test, respectively. Inter-rater differences were analyzed using Friedman test and Student-Newman-Keuls test for multiple comparisons. Results: Orthodontists dealing with oral clefts rehabilitation considered the majority of the sample as esthetically pleasant. Plastic surgeons of the cleft team and laypersons classified most of the sample as esthetically acceptable. Most of the orthodontists and plastic surgeons not related to cleft care evaluated the facial profile as esthetically unpleasant. The structures associated to unpleasant profiles were the nose, the midface and the upper lip. Conclusions: The facial profile of children with BCLP was classified as esthetically acceptable by laypersons. Professionals related to cleft rehabilitation were more lenient and those not related to cleft care were stricter to facial esthetics than laypersons.

Objetivo investigar se o ceceio, quando identificado, difere entre as fricativas alveolares não vozeadas e vozeadas produzidas por crianças com fissura labiopalatina operada. Métodos estudo prospectivo, em que frases constituídas pelas consoantes [s] e [z] produzidas por 32 crianças com fissura labiopalatina operada (idade média, 8 anos, 8 meses) foram selecionadas de um banco de dados e posteriormente julgadas auditivamente. Todas as crianças apresentavam relação inter-arcos alteradas, conforme avaliação ortodôntica realizada por três ortodontistas (concordância inter-juiz quase perfeita, kappa= 0.81), a partir da análise de modelos de gesso. Três fonoaudiólogas julgaram auditivamente as produções áudio gravadas. A concordância inter-juízes variou entre 56% e 78% e entre 59% e 93% para as frases constituídas de [s] e [z], respectivamente. Resultados o ceceio foi identificado em 69% das crianças e, particularmente, em 72% e 50% das produções envolvendo [s] e [z], respectivamente. Houve diferença significante entre os julgamentos para as fricativas [s] e [z], com maior ocorrência de ceceio em [s]. Conclusões deformidades dentofaciais podem favorecer a ocorrência do ceceio na população com fissura labiopalatina. A maior ocorrência do ceceio em [s] em comparação à [z], a partir da identificação auditiva, pode ser justificado por razões acústicas e/ou articulatórias. Sugere-se que o ceceio é dependente do contexto fonético-fonológico da frase devendo o mesmo ser considerado para fins clínicos e de pesquisa.

Purpose to investigate whether lisp, when identified, differs between voiced and unvoiced alveolar fricatives produced by children with cleft palate. Methods a prospective study in which sentences comprising the consonants [s] and [z] produced by 32 children with cleft palate (mean age, 8 years, 8 months) were selected and after auditory judged. All children presented altered inter-relationship arches as evaluated by three orthodontists (inter-judge agreement almost perfect kappa = 0.81), performing analysis of dental casts. Three Speech-Language-Pathologists judged perceptually audio recorded productions. The inter-judges agreement ranged between 56% and 78% and between 59% and 93% for the phrases consisting of [s] and [z], respectively. Results the lisp was identified in 69% of children, particularly, in 72% and 50% [s] and [z] sounds, respectively. There were significant differences between judgments for the fricatives [s] and [z], with higher prevalence of lisping in [s]. Conclusions dentofacial deformities may favor the occurrence of lisp in population with cleft palate. The increased occurrence of lisp in [s] compared to [z], based on auditory perceptual identification, can be justified by acoustic and / or articulatory reasons. It is suggested that lisp is dependent of the phonetic-phonological context of the sentence and therefore must be considered for clinical and research purposes.

OBJETIVO: o propósito deste estudo foi avaliar radiograficamente a prevalência das anomalias dentárias de número (agenesias e supranumerários), na dentição permanente, em diferentes subfenótipos da fissura isolada de palato, em pacientes pré-adolescentes. MÉTODOS: foram investigadas, de forma retrospectiva, 300 radiografias panorâmicas de pacientes com fissura palatina (pós-forame), de 9 a 12 anos de idade, matriculados em um mesmo centro. A amostra foi dividida em dois grupos de acordo com a extensão/gravidade da fissura palatina: completa e incompleta. O teste qui-quadrado foi utilizado para comparação intergrupos das prevalências de anomalias avaliadas (p < 0,05). RESULTADOS: a agenesia dentária foi encontrada em 34,14% dos pacientes com fissura pós-forame completa e em 30,27% com fissura pós-forame incompleta. A prevalência de dentes supranumerários correspondeu a 2,43% nos pacientes com fissura palatina completa e a 0,91% no grupo com fissura palatina incompleta. Não houve diferença estatística significativa entre os grupos quanto à prevalência de agenesias dentárias e supranumerários. Não se observou diferença sexual quanto à prevalência de fissura dentro de cada grupo de estudo. CONCLUSÃO: os pacientes pré-adolescentes com fissura palatina apresentam maior prevalência de anomalias dentárias em relação à população em geral. A gravidade da fissura palatina parece não se associar com a prevalência de anomalias dentárias de número.

OBJECTIVE: This study aimed at carrying out a radiographic analysis on the prevalence of dental anomalies of number (agenesis and supernumerary teeth) in permanent dentition, in different subphenotypes of isolated cleft palate pre-adolescent patients. METHODS: Panoramic radiographs of 300 patients aged between 9 and 12 years, with cleft palate and enrolled in a single treatment center, were retrospectively analyzed. The sample was divided into two groups according to the extension/severity of the cleft palate: complete and incomplete . The chi-square test was used for intergroup comparison regarding the prevalence of the investigated dental anomalies (P < 0.05). RESULTS: Agenesis was found in 34.14% of patients with complete cleft palate and in 30.27% of patients with incomplete cleft palate. Supernumerary teeth were found in 2.43% of patients with complete cleft palate and in 0.91% of patients with incomplete cleft palate. No statistically significant difference was found between groups with regard to the prevalence of agenesis and supernumerary teeth. There was no difference in cleft prevalence between genders within each study group. CONCLUSION: The prevalence of dental anomalies of number in pre-adolescents with cleft palate was higher than that reported for the general population. The severity of cleft palate did not seem to be associated with the prevalence of dental anomalies of number.

The Laboratory of Physiology provides support for the diagnosis of functional disorders associated with cleft lip and palate and also conducts studies to assess, objectively, the institutional outcomes, as recommended by the World Health Organization. The Laboratory is conceptually divided into three units, namely the Unit for Upper Airway Studies, Unit for Stomatognathic System Studies and the Unit for Sleep Studies, which aims at analyzing the impact of different surgical and dental procedures on the upper airways, stomatognathic system and the quality of sleep of individuals with cleft lip and palate. This paper describes the main goals of the Laboratory in the assessment of procedures which constitute the basis of the rehabilitation of cleft lip and palate, i.e., Plastic Surgery, Orthodontics and Maxillofacial Surgery and Speech Pathology.

Treatment of patients with cleft lip and palate is completed with fixed prostheses, removable, total, implants and aims to restore aesthetics, phonetics and function and should be guided by the basic principles of oral rehabilitation, such as physiology, stability, aesthetics, hygiene and the expectations of the patient. In order to obtain longevity of a prosthetic rehabilitation, the periodontal and dental tissue as well as the biomechanics of the prosthesis are to be respected. The purpose of this article is to describe the types of prosthetics treatment, which are performed at HRAC/USP for the rehabilitation of cleft area in adult patients.

This paper presents the treatment protocol of maxillofacial surgery in the rehabilitation process of cleft lip and palate patients adopted at HRAC-USP. Maxillofacial surgeons are responsible for the accomplishment of two main procedures, alveolar bone graft surgery and orthognathic surgery. The primary objective of alveolar bone graft is to provide bone tissue for the cleft site and then allow orthodontic movements for the establishment of an an adequate occlusion. When performed before the eruption of the maxillary permanent canine, it presents high rates of success. Orthognathic surgery aims at correcting maxillomandibular discrepancies, especially anteroposterior maxillary deficiencies, commonly observed in cleft lip and palate patients, for the achievement of a functional occlusion combined with a balanced face.

OBJETIVO: avaliar e determinar o padrão de crescimento facial de indivíduos com fissura pós-forame incisivo. MÉTODOS: esse estudo transversal retrospectivo usou fotografias frontais e de perfil de uma amostra de 71 pacientes matriculados no HRAC-USP (Bauru/SP), sendo 22 indivíduos do sexo masculino e 49 do feminino, jovens adultos brasileiros, com idade média de 17 anos e 8 meses, sem tratamento ortodôntico prévio ou síndromes associadas. O método utilizado foi o diagnóstico facial subjetivo, baseado em conceitos técnicos, constando da análise morfológica qualitativa da face. Os indivíduos foram classificados, por dois ortodontistas do HRAC/USP, com base no conceito de padrão sugerido por Capelozza Filho: Padrão I, II, III, Face Longa e Face Curta. RESULTADOS: a distribuição na análise morfológica frontal encontrada foi: Padrão I (69%), Padrão II (6%), Padrão III (7%), Padrão Face Longa (18%) e Padrão Face Curta (0%). Na análise morfológica de perfil, a distribuição encontrada foi: Padrão I (35%), Padrão II (38%), Padrão III (10%), Padrão Face Longa (17%) e Padrão Face Curta (0%). A distribuição no aspecto frontal foi muito positiva, já que os indivíduos Padrão I predominaram. Na análise do perfil, as displasias anteroposteriores foram expressas em essência, aumentando significativamente sua participação. Já o Padrão Face Longa manteve um equilíbrio em ambas as avaliações e o Padrão Face Curta não foi encontrado na amostra utilizada, provavelmente devido à baixa prevalência na população geral. CONCLUSÃO: a prevalência dos diversos padrões faciais para os pacientes com fissura pós-forame incisivo foi semelhante à encontrada para indivíduos sem fissura.

OBJECTIVE: The assessment and establishment of the facial growth pattern for patients with a cleft palate. MATERIAL: This cross-sectional retrospective study was based on front and profile photos of a sample of 71 patients at the HRAC-USP, 22 males and 49 females, Brazilians, young adults, with a mean age of 17 years 8 months, without previous orthodontic treatment and no associated syndromes. The method was the subjective facial diagnosis based on technical concepts, that is, the qualitative morphologic analysis of the face through clinical examination. Individuals were classified as Pattern I, II, III, Long Face or Short Face. RESULTS: The distribution found with the frontal morphologic analysis was: Pattern I (69%), II (6%), III (7%), Long (18%) and Short (0%). As for the profile morphologic analysis, the distribution was: Pattern I (35%), II (38%), III (10%), Long (17%) and Short (0%).The distribution observed in the frontal analysis was very positive, since individuals Pattern I prevailed. For the profile evaluation, the anterior-posterior dysplasias were essentially shown, significantly increasing their participation. Long Face Pattern maintained a balance in both ratings and Short Face Pattern was not found in the sample used, probably related to the low prevalence in the general population. CONCLUSION: The prevalence of different Facial Patterns for patients with cleft palate was similar to that found in individuals without cleft.

OBJECTIVE: This study compared the dental arch morphology of adult patients with isolated cleft palate in order to verify the influence of palatoplasty on occlusion. METHODS: Cast models of 77 patients, 30 males and 47 females, with an average age of 21 years and no syndromes were taken. They were in the permanent dentition and had not undergone orthodontic treatment. The sample was divided into non-operated and operated patients, the latter having been submitted to palatoplasty at a mean age of 2.2 years. RESULTS: Almost 80% of the sample exhibited sagittal discrepancies in the inter-arch relationship, with a Class II malocclusion prevailing (59.74%) followed by Class III (20,78%), regardless of palatoplasty. Transverse analysis showed a 23% incidence of posterior crossbite also not influenced by palatoplasty. Intra-arch relationship indicated that constriction and crowding on the upper arch were more frequent in the operated group (p=0.0238 and p=0.0002, respectively), showing an influence of palatoplasty on its morphology. The predominant morphological characteristics in patients with isolated cleft palate were a Class II malocclusion, upper dental arch constriction and upper and lower anterior crowding. CONCLUSION: The influence of palatoplasty was restricted to constriction and crowding of the upper dental arch, with no interference from the extension of the cleft, except for the upper crowding, which occurred more in patients with complete cleft palates.

The aim of this article is to present the pediatric dentistry and orthodontic treatment protocol of rehabilitation of cleft lip and palate patients performed at the Hospital for Rehabilitation of Craniofacial Anomalies - University of São Paulo (HRAC-USP). Pediatric dentistry provides oral health information and should be able to follow the child with cleft lip and palate since the first months of life until establishment of the mixed dentition, craniofacial growth and dentition development. Orthodontic intervention starts in the mixed dentition, at 8-9 years of age, for preparing the maxillary arch for secondary bone graft procedure (SBGP). At this stage, rapid maxillary expansion is performed and a fixed palatal retainer is delivered before SBGP. When the permanent dentition is completed, comprehensive orthodontic treatment is initiated aiming tooth alignment and space closure. Maxillary permanent canines are commonly moved mesially in order to substitute absent maxillary lateral incisors. Patients with complete cleft lip and palate and poor midface growth will require orthognatic surgery for reaching adequate anteroposterior interarch relationship and good facial esthetics.

Cleft lip and palate is the most common among craniofacial malformations and causes several esthetic and functional implications that require rehabilitation. This paper aims to generally describe the several aspects related to this complex pathology and the treatment protocol used by the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC-USP) along 40 years of experience in the treatment of individuals with cleft lip and palate.

OBJETIVO: o presente trabalho tem como objetivo acompanhar radiograficamente a evolução da ossificação da sutura palatina mediana em pacientes submetidos à expansão rápida da maxila, bem como comprovar a validade de se avaliar a neoformação óssea através deste exame complementar de diagnóstico. METODOLOGIA: a amostra constou de 38 pacientes no estágio de dentadura mista que se submeteram ao protocolo de expansão rápida da maxila, sendo 2/4 de volta pela manhã e 2/4 de volta à noite, totalizando 1 volta completa por dia, compreendendo um período de 7 dias. RESULTADOS: radiografias oclusais de maxila tomadas no pós-tratamento evidenciaram uma variação individual quanto ao período necessário para a completa neoformação óssea da sutura palatina mediana. A imagem radiográfica apresentou-se como um método confiável para a determinação da época correta de remoção do aparelho expansor. Tendo em vista a estabilidade pós-tratamento a longo prazo, o aparelho expansor deve ser removido somente após a completa ossificação da sutura. CONCLUSÕES: os resultados revelaram que são necessários mais de três meses para que o processo de ossificação e reorganização sutural se processe após o procedimento de expansão rápida da maxila.

OBJECTIVE: the current study aims at following up radiographically the evolution of the midpalatal suture during the expansion procedure since the opening of the suture until bone formation. METHODS: the sample comprised 38 patients in the mixed dentition stage submitted to the rapid palatal expansion protocol of the Hospital for Rehabilitation of Craniofacial Anomalies. RESULTS: it was observed an individual variation on the period of bone ossification of the midpalatal suture, which justifies the radiographic follow-up as determinant for the appliance removal. Due to long-term post-treatment stability, the expander should be removed after the new suture is completely formed. CONCLUSIONS: the findings show that it is necessary more than three months for the complete reorganization of the midpalatal suture during the passive phase of the rapid palatal expansion.