Digital Poster

Abstract

Objectives: The care of patients with cleft lip and/or cleft palate is not standardized across centres. High quality and evidence-based standards to guide clinical decision-making are critical. The objective of this review is to appraise the scope, quality, adequacy, consistency, and limitations of guidelines relating to the management of CL/CLP in children across all disciplines of care.
Design: (PRISMA) guidelines, MEDLINE, EMBASE, SCOPUS, Web of Science, and Cochrane Database of Systematic Reviews databases were systematically searched for guidelines relating to the care and management of children with CL/CLP. Guidelines were assessed utilizing the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument.

Results: Fifty-Four standards were selected for inclusion. Most studies were performed in the United States (44.4%) and United Kingdom (38.9%). Standards consisted of primarily expert consensus recommendations (38%). Recommendations were principally developed by a task force or after expert consensus (39.6%). Recommendations were coded according to nine thematic domains: "Feeding ", "Orthodontics", "Surgery", "Speech", "Breathing”, “Appearance", "Psychosocial Outcome", "Team Composition and Dynamics", and "Cost of Care ". No guideline encompassed all domains. Discrepancies were observed across domains, guideline setting, and data collection method.

Conclusions: Existing guidelines can effectively be organized into nine categories. Based on appraised quality of evidence for recommendations, they are supported by moderate quality of evidence and should be utilized to guide clinical decision-making to improve outcomes for CL/CLP patients. Nonetheless, there is an ongoing need for high-quality practice guidelines for comprehensive CL/CLP care.

A Review of Orthodontic Considerations before and after Alveolar Bone Grafting in Patients with Cleft Lip and Palate*

Cecile Tuano Cabrera, DMD, MSD

Noordhoff Craniofacial Foundation Philippines
College of Dentistry, University of the Philippines Manila
Smile Train Craniofacial Center, Manila
Our Lady of Peace Hospital, Paranaque

Introduction
Successful orthodontic management in cleft lip and palate, in relation alveolar bone grafting depends on key factors: timing, treatment sequencing, pre-graft preparation and post-graft management. This review highlights current management concepts and protocols.

Methods
A selective literature search was conducted using PubMed and Google Scholar with keywords related to alveolar bone grafting, orthodontics, cleft lip and palate, maxillary expansion, and maxillary protraction.

Results and Key Findings
Assessment should begin at the mixed dentition stage to determine optimal timing and sequence of grafting and related procedures. Regular clinical and radiographic evaluation is essential. Indications for pre‑graft orthodontics include severe collapse of alveolar segments, traumatic occlusion near the cleft, and inadequate surgical access. Grafting is ideally performed when the canine root adjacent to the cleft is one‑half to two‑thirds developed, though some centers graft earlier when the lateral incisor is adjacent. After grafting, maxillary expansion may be performed in patients who have not received pre-graft orthodontics. Some patients may benefit from maxillary protraction during the late mixed or early permanent dentition stage. Following bone graft surgery, orthodontic treatment may either proceed—depending on the individual case—or be paused until the patient achieves full skeletal maturity.

Conclusion
Orthodontic care is integral to interdisciplinary management of cleft lip and palate. Each patient presents unique needs, and collaboration among cleft team members is vital to create individualized treatment plans that optimize outcomes.

*This article was published in: Acta Medica Philippina in 2024. Free full text link in Pubmed: https://pmc.ncbi.nlm.nih.gov/articles/PMC11694040/

INTRODUCTION: Social media platforms are used for support and getting health information to manage or overcome disease. Since 2006, The Noordhoff Craniofacial Foundation Philippines, Inc. (NCFP) has provided subsidies for treatment of cleft lip and palate to indigent patients. In 2018, it began utilizing Facebook and Messenger to foster supportive environments for patient communication and education. The study objective was to determine the perception of using these platforms.

METHODS: A quantitative descriptive study design was employed. Cleft lip and palate patients or their caregivers answered a 6-part online questionnaire. The survey included questions on general information and their perception of the NCFP platforms. Responses were collected in 4 weeks, and data were analyzed using STATA ver.16.0.

RESULTS: The 138 participants were members of 1, 2, or all 3 groups. Of the participants, 90.6% (125) were part of the Facebook Group (Group I), 12.3% (17) were part of the Peer Messenger Group (Group II), and 21.7% (30) were part of the Parents’ Messenger Group (Group III). Group I was found to be the easiest to use by 76.8% of the respondents. In total, 94.6% of Group I, 48.5% of Group II, and 47.3% of Group III thought these groups helped them in treatment decision-making. The 45%, 25.7%, and 28% for Groups I, II, and III, respectively felt a decrease in their perceived need for in-person visits. Patient satisfaction was 95.4%, 50.5%, and 52.7% in Groups I, II, and III, respectively.

CONCLUSION: The perception on the use of social media platforms is different among the 3 groups. Group I ranked the highest in ease of use and help with decision-making but less than half the participants found that the 3 groups led to a decrease in the perceived need for in-person visits. Overall, their experience of using social media groups was positive.