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Changing Perspectives in Cleft Lip and Palate:  From Acrylic to Allele

Travis T. Tollefson, MD; Craig W. Senders, MD; Jonathan M. Sykes, MD
Arch Facial Plast Surg. 2008;10(6):395-400. doi:10.1001/archfaci.10.6.395.
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Cleft lip and palate deformities are the most common congenital abnormalities of the head and neck. Advancements in the various multidisciplinary fields involved in cleft management have substantially improved functional and aesthetic outcomes. The legitimacy of such controversial topics as gingivoperiosteoplasty, primary rhinoplasty, and presurgical nasoalveolar molding is heavily contested. Bone morphogenetic protein and other recombinant growth factors may play important roles in future cleft care. As the candidate alleles that contribute to cleft lip and palate are further elucidated, the complex interplay of environmental influence and genetic predisposition is emphasized. Translational research from fields such as fetal wound healing, tissue engineering, and gene therapy may have clinical applications as cleft care continues to evolve.

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Figure 1.

Schematic timeline for treatment of children with cleft lip and palate. PNAM indicates presurgical nasal alveolar molding.

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Figure 2.

Use of presurgical nasal alveolar molding. A, Presurgical nasal alveolar molding appliance with nasal prongs to the left. Arrow marks where elastic bands are secured and taped to the cheeks. B, Six-week-old infant with bilateral cleft lip and palate demonstrating asymmetric protruding premaxilla. C, Same patient 2 weeks after primary cleft lip repair and rhinoplasty.

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Figure 3.

Neonatal mandibular distraction osteogenesis. A, Lateral 3-dimensional radiograph of a neonate with Pierre Robin sequence demonstrating severe micrognathia leading to airway obstruction. B, Postoperative view of the mandible after distraction osteogenesis.

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