Frontal cephalometric study of dentofacial morphology in children with bilateral clefts of lip, alveolus and palate

Comparison of Transverse Craniofacial Dimensions Between Growing Individuals With Unilateral Cleft Lip and Palate and Age-and Sex-Matched Noncleft Controls

OBJECTIVE

The study aimed to assess the transverse craniofacial dimensions of patients (age, 7-14 years) with unilateral cleft lip and palate (UCLP), compare these dimensions with those of noncleft individuals, and identify the correlations between the nasal and maxillary transverse widths of patients with UCLP.

DESIGN

A cross-sectional study.

PARTICIPANTS

Eighty patients operated on for complete UCLP (UCLP group; 35 girls, 45 boys; median age: 10.7 [7.9-14] years) and 80 age- and sex-matched noncleft individuals (control group; 35 girls, 45 boys; median age: 10.7 [7.3-14] years).

INTERVENTIONS

Interorbital, bizygomatic, nasal, maxillary skeletal, maxillary molar, mandibular molar, and antegonial width measurements were performed using posteroanterior cephalometric radiographs. Intergroup comparisons were conducted by using the independent samples t-test and Mann-Whitney U test. Correlation between the variables was examined using Pearson correlation analysis.

RESULTS

The bizygomatic, maxillary skeletal and molar, mandibular molar, and antegonial widths in the UCLP group were significantly less than those in the control group (P < .05). A positive correlation was found between the maxillary skeletal and nasal widths (r = 0.550, P < .001) and between the maxillary molar and nasal widths (r = 0.560, P < .001).

CONCLUSIONS

In individuals with UCLP, the bizygomatic, maxillary skeletal and molar, mandibular molar, and antegonial widths were significantly less than those in noncleft individuals. As the maxillary skeletal and dental widths presented a positive correlation with the nasal width, a decrease in nasal width must be considered when maxillary constriction is noted.

Facial profile and maxillary arch dimensions in unilateral cleft lip and palate children in the mixed dentition stage

Objectives:

The aim of this study was to evaluate the vertical and sagittal facial profile and maxillary arch width, depth, and length of patients with unilateral cleft lip and palate (UCLP) and to compare them with healthy noncleft children in the mixed dentition stage (7–13 years).

Materials and Methods:

This study is conducted at Hospital Universiti Sains Malaysia. UCLP group comprised 48 patients with nonsyndromic UCLP who have had the lip and palate repaired, whereas the control group comprised 48 healthy noncleft cases. The lateral cephalometrics measurements were used to determine the vertical height, sagittal depth of the face, and cranial base length and angle. Maxillary arch dimensions were measured on the study cast including arch width, depth, and length.

Results:

Vertical facial height and sagittal depth measurements showed a significant decrease (P < 0.05) in the mean growth pattern in UCLP group. The anterior cranial base length (S-N) was shorter in UCLP children (P < 0.001), while Ba-N length had no significant difference (P = 0.639). Nasion-Sella Tursica-Basion angle was significantly higher in the UCLP group (P = 0.016). Dental arch width with reference to canine-to-canine and first premolar-to- first premolar distance was significantly larger in control (P = 0.001).

Conclusion:

Mean vertical and sagittal facial dimensions in the UCLP children who do not undergo orthodontic treatment are significantly lesser in all directions of growth than healthy noncleft children. The maxillary dental arch had a normal depth but constricted in width and arch length.

Evaluation of mandibular transverse widths in patients affected by unilateral and bilateral cleft lip and palate using cone beam computed tomography

OBJECTIVE

To evaluate the mandibular dental, alveolar, and skeletal transversal widths in patients affected by unilateral (UCLP) and bilateral (BCLP) cleft lip and palate and to compare the findings with a well-matched normal occlusion sample using cone beam computed tomography images.

MATERIALS AND METHODS

The study sample consisted of 75 patients divided into three groups: the UCLP (29 patients; mean age: 15.40 ± 3.22 years), BCLP (18 patients; mean age: 15.54 ± 3.72 years), and normal occlusion (28 patients; mean age: 15.82 ± 2.11 years) groups. Mandibular dental (intercanine and -molar), alveolar (intercanine and -molar), and skeletal (bigonial width) transversal measurements were performed three-dimensionally and analyzed using the one-way variance analysis and post hoc Tukey tests.

RESULTS

Patients affected by UCLP and BCLP had statistically significantly lower intercanine alveolar widths (P < .05 and P < .001, respectively) and larger intermolar (P < .001 and P < .05, respectively) and intermolar alveolar widths (P < .001) compared with the normal occlusion group. Furthermore, the patients affected by UCLP and BCLP had similar mandibular dental, alveolar, and skeletal transversal widths (P > .05).

CONCLUSION

The UCLP and BCLP groups showed statistically significantly smaller values for intercanine alveolar widths and larger values for intermolar dental and alveolar widths compared with the normal occlusion group. This shows the importance of using individualized archwires according to the pretreatment arch widths of the patients affected by UCLP and/or BCLP.

Maxillary expansion as an interceptive treatment for impacted canines

DESIGN

This was a randomised controlled trial.

INTERVENTION

Patients in the control group received no treatment, whereas the patient treatment group had a rapid maxillary expander soldered to bands placed on the second deciduous molars or the first permanent molars. Activation of the screw was continued until the palatal cusps of the maxillary posterior teeth were in contact with the buccal cusps of the mandibular posterior teeth. Once the required expansion was achieved, the expansion screw was locked in position. After expansion, all patients were retained with the expander in place for 6 months after which the patients wore a retention plate at night for 1 year.

OUTCOME MEASURE

The main outcome was successful or unsuccessful eruption of the maxillary permanent canines.

RESULTS

The sample comprised 54 patients (32 in the treatment group and 22 in the control). No statistically significant differences were found for any variable at baseline. The prevalence rates of successful eruption of the maxillary canines were 65.7% (21 subjects) in the treatment group and 13.6% (three subjects) in the control. The comparison was statistically significant (chi-square, 12.382; P >0.001).

CONCLUSIONS

The use of rapid maxillary expansion (RME) in the early mixed dentition appears to be an effective procedure to increase the rate of eruption of palatally displaced maxillary canines (PDC) compared with an untreated control group.

Changes of vertical skeletal morphology in patients with complete unilateral and bilateral cleft lip and palate

OBJECTIVE

The aim of this retrospective investigation was to qualify and quantify changes of the vertical skeletal morphology during puberty in cleft patients compared with an age-matched noncleft control.

METHODS

Patients with unilateral cleft lip and palate (UCLP; n = 12) and bilateral cleft lip and palate (BCLP; n = 11) who fulfilled strict inclusion criteria according to the Hanover treatment protocol were evaluated by means of cephalometric analysis. Lateral cephalograms were analyzed for each cleft patient at age 10 and 15 and compared with corresponding data of a noncleft control (n = 20).

RESULTS AND CONCLUSIONS

It was concluded that a vertical growth impairment of the maxilla is found in patients with cleft lip and palate. The maxilla of cleft patients shows a significant clockwise rotation, whereas the inclination of the mandible shows little difference. Consequently, there is a skeletal superposition of the jaws. The posterior height of the maxilla is significantly shorter in patients both with UCLP and BCLP at T(0) and T(1). An increase of the anterior height of the mandible is found in the cleft groups.

Long-term results of the two-stage palatoplasty/Hotz' plate approach for complete bilateral cleft lip, alveolus and palate patients

PURPOSE

To investigate the effects of the two-stage palatoplasty combined with the Hotz' plate on craniofacial development in patients with bilateral complete clefts.

MATERIAL AND METHODS

Lateral and frontal cephalograms of two-stage palatoplasty/Hotz' plate group (n=10), one-stage palatoplasty group (n=11), and a non-cleft group (n=11), were evaluated at 6, 8, 10 and 12 years of age. The unpaired Student's t-test and Scheffe's F test (p<0.05) were applied.

RESULTS

At 6 years the posterior upper facial height (PUFH) and PUFH/PFH ratio were greater in the two-stage group. At 10 years the PUFH, maxillary depth, convexity and ANB angle were greater in the same group. At 12 years, maxillary depth and ANB angle were also greater in this group. In the one-stage group, the L1/Mp. angle, PUFH and PUFH/PFH ratio were smaller when compared with the non-cleft group, whereas the palatal plane/SN angle was greater. In both cleft groups, the I.I. angle and tongue-PTM' distance were greater, and the U1/SN angle was smaller when compared with non-clefts. The UC-UC' and the ratios UC/MAX and UC/LC of both cleft groups were also smaller when compared with non-clefts. The ratio UM/MAX of the one-stage group was smaller when compared with the non-cleft group.

CONCLUSION

The two-stage palatoplasty in combination with application of the Hotz' plate had good effects on the maxillary growth up to the age of 12 years.

Cranial base and facial skeleton asymmetries in individuals with unilateral cleft lip and palate

OBJECTIVE

Individuals with unilateral cleft lip and palate (UCLP) manifest a plethora of phenotypic characteristics, including asymmetric development of the middle and lower facial skeleton. The purpose of this study was to retrospectively investigate the development of cranial base asymmetries in patients with UCLP noted on posteroanterior cephalometric radiographs.

METHODS

Thirty individuals with UCLP and 64 controls participated in this study. Medial and lateral cranial base asymmetries were analyzed on frontal cephalometric radiographs relative to three developmental stages. Furthermore, the development of horizontal and vertical lower facial asymmetry in these patients with UCLP was assessed in relation to cranial base, nasomaxillary, and dentoalveolar structures.

RESULTS

Individuals with UCLP demonstrated cranial base asymmetries that did not significantly differ from individuals without cleft. In addition, lower facial asymmetry in patients with UCLP correlated with horizontal lower facial and dentoalveolar asymmetries but not with cranial base or nasomaxillary structures.

CONCLUSIONS

No significant vertical cranial base asymmetries were detected in patients with UCLP. Horizontal lower facial asymmetry appeared to develop in close relation to the vertical asymmetries of mandibular fossae and dentoalveolus.

Mandibular asymmetry in noncleft and unilateral cleft lip and palate individuals

OBJECTIVE

The purpose of this study was to retrospectively investigate mandibular asymmetry in unilateral cleft lip and palate individuals (UCLP) in relation to chronologic age and in relation to lower facial asymmetry.

DESIGN

The longitudinal records of 34 UCLP individuals and 142 controls treated in the Department of Orthodontics, Eastman Dental Center, Rochester, NY, were included in the study. Posteroanterior and oblique cephalometric radiographs were analyzed for lower facial asymmetry and mandibular asymmetry, respectively. Mandibular asymmetry in UCLP was analyzed relative to three age groups (6-10, 11-14, and 15 or greater) and compared to controls. Moreover, mandibular asymmetry was analyzed relative to lower facial asymmetry.

RESULTS

UCLP individuals showed no significant differences in mandibular asymmetry compared to controls. In addition, no significant correlation was found between mandibular asymmetry and lower facial asymmetry in UCLP.

CONCLUSIONS

The degree of mandibular asymmetry in UCLP appears not to be the major contributing factor to the lower facial asymmetry noted on these individuals. Possible cranial-base/temporal-region anomalies may be involved in unilateral cleft lip and palate and be responsible of the asymmetry noted in the lower facial skeleton.

Data and patterns of transverse dentofacial structure of 6- to 15-year-old children: a posteroanterior cephalometric study

The aims of the present cross-sectional investigation were to provide normative data of selected dentofacial posteroanterior cephalometric measures and to describe the patterns of transverse dentofacial structure. The material comprised the P-A cephalograms of 588 Austrian schoolchildren (157 girls and 431 boys, who were 6 to 15 years old). All subjects were healthy, presented various types of occlusions, and did not receive orthodontic or orthopedic therapy. In studying the P-A cephalograms, 8 linear and 2 angular variables, as well as 10 ratios were used. The results of the study revealed that all skeletal widths and all ratios representing relations between the various breadths of the facial skeleton and the interorbital width demonstrated an increase when the measurements at the initial and final ages of 6 and 15 years, respectively, were compared. However, the maxillary intermolar width during the period from 9 to 12 years did not present any increase, and the mandibular intermolar width remained approximately the same during the whole observation period. The transverse dentoalveolar relationship in the incisal region remained very symmetric during aging. The standard deviations of most cephalometric variables were small when they were compared with their corresponding mean values. The present data are of value for the diagnosis of various types of dentofacial anomalies, for monitoring growth of persons or groups of corresponding age and race, and for comparison with other studies.

Three-dimensional evaluation of dentoskeletal changes after posterior cross-bite correction by quad-helix or removable appliances

The aim of the study was to evaluate in a three-dimensional manner the dentoskeletal changes after slow maxillary expansion. The sample consisted of 34 children with a unilateral, symmetrical posterior cross-bite. Half of the children were treated with a quad-helix and the rest with a removable appliance. Assessment of the changes was made with study casts, and frontal and lateral cephalograms, before treatment, at the end of the expansion, after a retention period of 3 months, and after a post-retention period of 3 months. The results showed that sufficient expansion of the dental arches took place in both groups. The expansion expressed in the molar region in the quad-helix group was mostly due to buccal translation of the teeth and in the removable appliance group due to buccal tipping. The quad-helix group showed somewhat greater basal expansion than the removable appliance group, though the basal expansion in both groups was rather small. A tendency towards an increase of the NL/ML angle characterized the removable appliance group, but the opposite pattern was present in the quad-helix group.

Frontal cephalometric evaluation of transverse dentofacial morphology and growth of children with isolated cleft palate

The transverse dentofacial morphology and growth of 64 children operated on for clefting of the hard and soft palate was studied by means of a frontal proportional cephalometric analysis and was compared to a normal sample at the ages 3-4, 8-9 and 12 years. The cross-sectional comparison of the cleft palate and normal samples at the three periods indicated: (a) The presence in the cleft group of significantly increased ratios of the inner orbital width to the interorbital width and of the width of the nasal cavity to the interorbital width; (b) the absence of any significant differences in the ratio of the maxillary intermolar width to the interorbital width; and (c) the presence of almost identical ratios of the intergonial width of the mandible to the interorbital width and of the width of the maxilla to the intergonial width of the mandible. Evaluation of the changes of all cephalometric variables during the period 8-12 years showed the absence of any significant difference between the cleft palate and normal groups.