Dentocraniofacial Morphology of 21 Patients with Unilateral Cleft Lip and Palate: A Cephalometric Study

Maxillary Development and Dental Arch Relationships Following Early Two-Stage Palatoplasty: A Comparative Study

OBJECTIVE

To examine skeletal morphology and dental arch relationships at 8 years of age following early 2-stage palatoplasty, which consists of soft palate plasty at 1 year of age and hard palate closure at 1.5 years of age, and to compare the results with those of conventional pushback palatoplasty.

DESIGN

Retrospective.

SETTING

Single institutional study.

PATIENTS

Eighty-six patients with nonsyndromic complete unilateral cleft lip and palate (UCLP) were selected.

INTERVENTION

The subjects were divided into 2 groups according to the palatoplasty protocols, as follows: 45 patients, who underwent early 2-stage palatoplasty (ETS group), and 41 patients, who underwent 1-stage pushback palatoplasty (PB group).

MAIN OUTCOME MEASURES

Skeletal morphology was assessed using lateral cephalometric analysis, and dental arch relationships were examined using the GOSLON yardstick.

RESULTS

Cephalometric analysis revealed that the anterior-posterior length of the maxilla, measured by PTM-A and PTM-ANS, both projected to the nasal floor (NF) plane, was longer in the ETS group than in the PB group (PTM-A/NF, p = .04; PTM-ANS/NF, p = .03, unpaired t-test), although no significant difference was observed in SNA (p = .09, unpaired t-test). Upper posterior facial height was shorter in the ETS group than in the PB group (p = .02, unpaired t). Assessments with the GOSLON yardstick showed that the ETS group presented better dental arch relationships than the PB group (p = 0.04, Mann-Whitney's U-test).

CONCLUSIONS

The present results suggested that the ETS protocol reduced the negative effects of palatal surgery on facial development and dental arch relationships in patients with complete UCLP at 8 years of age.

A Cross-Sectional Study of the Dental Arch Relationship and Palatal Morphology after Cleft Surgery in Italian Children with Unilateral Cleft and Lip Palate

Dental arch relationships (DARs) and palatal morphology (PM) were evaluated in in non-syndromic complete unilateral cleft lip and palate (UCLP) Italian patients after surgery. Pre- and postnatal factors affecting the results were investigated. Sixty-six children with UCLP (40 boys and 26 girls, with a mean age of 10.1 ± 2.9 years), predominantly Caucasian (77%), were consecutively enrolled in this cross-sectional study. Twenty children had received a one-stage protocol consisting of an early periosteal palate surgical repair and lip closure and forty-six were submitted to a staged surgical protocol with delayed palate repair (DPR). A single clinician collected data on their medical history and carried out a dental examination. The DAR and PM were graded on dental casts according to the Eurocran index and dichotomised as favourable and unfavourable based on the treatment outcome. Multiple logistic regression analyses demonstrated that female sex (OR = 6.08, 95% CI: 1.47-25.23, p = 0.013), DPR (OR = 4.77, 95% CI: 1.14-19.93, p = 0.032) and the use of a neonatal plate (OR = 4.68, 95% CI: 1.27-17.16, p = 0.020) increased the odds of having favourable DAR, while only DPR (OR = 9.76, 95% CI: 2.40-39.71, p = 0.001) was significantly associated with a favourable PM. Based on these findings, only DPR had a significantly favourable effect on both DAR and DM in Italian children with complete UCLP.

Impact of Cleft Palate Anastomosis in Cleft Lip and Palate Patients with Coexisting Cleft Lip Anastomosis Scar Based on Cephalometric Measurements

(1) Background: This article focuses on examining components affecting the overbite, overjet, and the effect of palate surgery on craniofacial morphology with a concomitant cleft lip fusion scar, and a comparison of patients who had only a cleft lip fusion scar. Patients with unilateral cleft lip (UCL) and patients with unilateral cleft lip and palate (UCLP) were included in the study. We aimed to find if cephalometric parameters were significantly different in these groups. (2) Material and methods: The study group consisted of a lateral cranial radiograph of patients with UCLP (n = 30) and UCL (n = 30). Cephalometric radiographs were saved electronically, and cephalometric analysis was performed using a computer program. (3) Results: We observed that a statistically significant higher degree of maxillary prognathism occurred in the UCL than in the UCLP. We observed the anterior position of the upper lip in relation to E-line in patients with cleft lip. (4) Conclusions: The results present the effect of cleft palate surgery on further forward growth of the maxilla. There was a decreased ANB angle present in the skeletal class II in patients with UCL and UCLP. The SNB angle was not increased, and the reverse overjet was due to the rectroclination of the upper incisors and protruded lower incisors.

Midface Growth Potential in Unoperated Clefts: A Systematic Review and Meta-Analysis

ABSTRACT

Competing hypotheses for the development of midface hypoplasia in patients with cleft lip and palate include both theories of an intrinsic restricted growth potential of the midface and extrinsic surgical disruption of maxillary growth centers and scar growth restriction secondary to palatoplasty. The following meta-analysis aims to better understand the intrinsic growth potential of the midface in a patient with cleft lip and palate unaffected by surgical correction. A systematic review of studies reporting cephalometric measurements in patients with unoperated and operated unilateral cleft lip and palate (UCLP), bilateral cleft lip and palate (BCLP), and isolated cleft palate (ICP) abstracted SNA and ANB angles, age at cephalometric analysis, syndromic diagnosis, and patient demographics. Age and Region-matched controls without cleft palate were used for comparison. SNA angle for unoperated UCLP (84.5 ± 4.0°), BCLP (85.3 ± 2.8°), and ICP (79.2 ± 4.2°) were statistically different than controls (82.4 ± 3.5°), (all P ≤ 0.001). SNA angles for operated UCLP (76.2 ± 4.2°), BCLP (79.8 ± 3.6°), and ICP (79.0 ± 4.3°) groups were statistically smaller than controls (all P ≤ 0.001). SNA angle in unoperated ICP (n = 143) was equivalent to operated ICP patients (79.2 ± 4.2° versus 79.0 ± 4.3° P = 0.78). No unoperated group mean SNA met criteria for midface hypoplasia (SNA < 80). Unoperated UCLP/BLCP exhibit a more robust growth potential of the maxilla, whereas operated patients demonstrate stunted growth compared to normal phenotype. Unoperated ICP demonstrates restricted growth in both operated and unoperated patients. As such, patients with UCLP/BCLP differ from patients with ICP and the factors affecting midface growth may differ.Level of Evidence: IV.

Three-Dimensional Analysis of the Skull Base of Individuals With Cleft Lip and Palate

AIMS

Identify variations of skull base measurements in individuals with dentofacial deformities associated or not with cleft lip and palate and compare the results with individuals without dentofacial deformities.

METHODS AND RESULTS

The individuals were categorized into three different groups: dentofacial deformity without cleft malformation, dentofacial deformity associated with cleft lip and palate, and without facial deformity. The inclusion criteria were individuals over 18 years of age, without any intervention involving facial bones or structures of interest for the study and field of view encompassing from the glabella to the hyoid bone. Poor quality CT scans or lack of adequate medical records were considered exclusion criteria. In the analysis by computerized tomography using the Dolphin Imaging Software, the length determined by the Ba-S and S-N lines was evaluated, as well as the Ba-S-N angle formed by landmarks.

RESULTS

The length of S-N was not statistically different between the groups, the Ba-S length and the Ba-S-N angle demonstrated statistical difference.

CONCLUSION

There was statistically significant difference in the morphometry of the (Ba-S) between groups (FS) and (C). This suggests that the standard values for cephalometric analyzes involving these structures, especially to determine the treatment planning, should be used with caution.

A Meta-Analysis of Palatal Repair Timing

ABSTRACT

Developing midface hypoplasia is common after palatoplasty and has been hypothesized to be influenced by the timing of hard palate repair. This meta-analysis assesses the risk of developing midface hypoplasia based on age at hard palate repair. A Pubmed PRISMA systematic review and meta-analysis was completed for literature focused on palatoplasty and midface hypoplasia published between 1970 and 2019. Cephalometric data were extracted and categorized by age at hard palate repair: <6, 7 to 12, 13 to 18, 19 to 24, and 25 to 83 months. Analysis of these groups and a control were compared using independent T-tests and Spearman correlation coefficients. SNA angles for each group were 77.9 ± 3.1° (<6 months), 77.7 ± 4.2° (7-12 months), 78.7 ± 4.2° (13-18 months), 75.1 ± 4.2° (19-24 months), 75.5 ± 4.8° (25-83 months), and were statistically different than the control group 82.4 ± 3.5° (P < 0.0001). Hard palate repair at 13 to 18 months had a statistically significant greater SNA angle than all other groups except for the repair at <6 months group (P = 0.074). As age at hard palate closure increased beyond 18 months, the SNA decreased, corresponding to a more hypoplastic maxilla (Spearman's correlation coefficient -0.381, P = 0.015). Analysis suggests that younger age at the time of repair is less likely to create in midface hypoplasia in adulthood. Minimizing midface hypoplasia in cleft palate patients by optimizing algorithms of care is a practical way to decrease the burden of disease on patients, families and medical systems. Further studies are needed to evaluate the role of technique on outcomes.Level of Evidence: IV.

Retrognathic maxilla in individuals born with oral clefts is due to intrinsic factors and not only due to early surgical treatment

OBJECTIVES

To determine if the skeletal form of individuals born with oral clefts was associated with maxillary position.

MATERIALS AND METHODS

Lateral cephalometric radiographs of 90 individuals 8 to 12 years old born with or without cleft lip and palate paired by age and sex were used. Skull base length, cranial base angle, cranial deflection angle, and maxillary skeletal length and position were studied. Also, mandibular skeletal length and position, lower anterior facial height, and dental position were defined. Individuals were divided into three groups: 30 individuals born with cleft lip and palate with Class III malocclusion (UCLP Class III), 30 individuals born with cleft lip and palate with Class I malocclusion (UCLP Class I), and 30 individuals born without cleft lip and palate with Class III malocclusion (non-cleft Class III).

RESULTS

When comparing the UCLP Class III group with the UCLP Class I group, there were differences in maxillary position (P < .001) and mandibular position (P = .004) found. No differences were found when comparing the UCLP Class III group with the non-cleft Class III group.

CONCLUSIONS

There are intrinsic factors that affect craniofacial morphology of individuals born with cleft lip and palate.

Lateral cephalometric measurements of Iranians with surgically repaired unilateral cleft lips and palates

OBJECTIVES

Since results of surgical correction of unilateral cleft lip and palate (UCLP) are controversial, and there is no study in this regard among Iranians, this study was conducted to document lateral cephalometric measurements of such cases, with respect to age, gender, and cleft side.

METHODS

In this cross-sectional study, 45 lateral cephalographs of individuals with UCLP who had undergone surgery but not orthodontic treatment were traced and 30 skeletal, dental and soft-tissue cephalometric measurements were measured. Parameters were compared between patients with UCLP and cephalometric norms. They were also compared between males and females, two age groups (≤8 and>8 years), and sides of cleft using the Student's t-test.

RESULTS

Only S-N-Pog and U1-SN values were significantly different between this sample and cephalometric norms. The variables were not significantly different between males and females. However, the values of ANB, Wits appraisal, Go-Gn, Go-Pog, U1-SN, interincisal angle, distance of upper lip to Ricketts E-line, and nasopharyngeal depth were significantly different between patients≤8 and>8 years (P<0.05). The S-N-Pog angle, Wits appraisal, Go-Gn, Go-Pog, U1-SN, interincisal angle and hypopharyngeal depth were significantly different between patients with right- and left-side clefts (P<0.05).

CONCLUSION

Measurements of patients with repaired UCLP were similar to cephalometric norms except for two parameters.

Functional stability analyses of maxillofacial skeleton bearing cleft deformities

The symmetrically stable craniofacial bony structure supports the complex functions and delicate contour of the face. Congenital craniofacial deformities are often accompanied by bony defects and have been repetitively correlated with compromised dento-maxillary stability, but neither the extent nor the pattern of cleft-related maxillary instability has been explored in detail. Furthermore, it is largely unknown if the bony defect and related instability are correlated with secondary maxillary deformity common among patients with orofacial clefts. With the aid of finite element modeling, we studied the detailed relationship between cleft-related bony defect and maxillary stability under occlusal loading. Craniofacial models were generated based on cone-beam computed tomography data and loaded with mimicked bite forces along the axial axis of each tooth. Our data showed that all cleft models exhibited more asymmetrical deformations under mastication compared with the normal. Models with palatal cleft demonstrated greater asymmetry, greater dental arch contraction, and less maxillary protrusion compared to models with alveolar cleft only. For unilateral cleft models, alveolus on non-cleft side tended to be more protruded and lifted than the cleft side. For bilateral cleft models, the most prominent feature was the seriously contracted alveolar arch and curved and pitched premaxillae. These findings indicated cleft type-specific pattern of maxillary instability, which were largely in accordance with dentoalveolar morphological features among patients. Collectively, our study elucidated the detailed relationship between cleft bony defect and the pattern of maxillary instability, and suggested a prototype for studying the abnormal maxillary and dental arch growth among patients with craniofacial deformities.

Upper airway features of unilateral cleft lip and palate patients in different growth stages

OBJECTIVES

To compare growth-related changes of skeletal and upper airway features of unilateral cleft lip and palate subjects (UCLP) with non-cleft control (NCC) subjects by using lateral cephalograms.

MATERIALS AND METHODS

The sample comprised 238 subjects, collected cross-sectionally, divided into 2 groups: 94 with UCLP, and 144 NCC, subdivided into 4 groups according to their growth stages by using cervical vertebral maturation stage (CVMS). The subgroups were defined as early childhood (stage 1), prepubertal (stage 2: CVMS I and II), pubertal (stage 3: CVMS III and IV), and postpubertal (stage 4: CVMS V and VI).

RESULTS

The maxilla was more retrognathic at stages 2, 3, and 4 in females with UCLP. The mandible was more retrognathic in UCLP at stage 1 in males, and stages 2 and 3 in females. ANB (angle between NA plane and NB plane) was significantly smaller in UCLP subjects at stage 4 for both sexes. A vertical growth pattern was seen in UCLP subjects except males at stages 2 and 3, and females at stage 2. Posterior airway space was significantly narrower at all stages in males and after stage 1 in females. Middle airway space was significantly wider at all stages in females and after stage 1 in males. Epiglottic airway space was significantly narrower in males at stage 3.

CONCLUSIONS

Age- and sex-dependent differences in skeletal morphology and upper-airway widths of the UCLP subjects were identified when compared with controls.

Three-Dimensional Soft-Tissue Evaluation in Patients with Cleft Lip and Palate

BACKGROUND In cleft lip and palate (CLP) patients, the shape of the facial soft tissues shows variety in 3 dimensions (3D). Two-dimensional (2D) photographs and radiographs are insufficient in the examination of these anomalies. The aim of this retrospective study was to examine the soft tissue and craniofacial characteristics of individuals with nonsyndromic unilateral cleft lip and palate (UCLP), bilateral cleft lip and palate (BCLP), skeletal Class III malocclusions, or skeletal Class I malocclusions using 3D facial imaging. MATERIAL AND METHODS The entire study group consisted of a total of 158 patients, aged 8-32 years: 29 of the patients had UCLP, 22 BCLP, 54 had skeletal Class III malocclusions, and 53 had skeletal Class I malocclusions. 3D stereophotogrammetric soft-tissue recordings of all patients were analyzed. ANOVA and the Kruskal-Wallis test were performed to compare the groups. RESULTS Statistically significant differences were observed among the groups in terms of linear, angular, proportional. and volumetric measurements. While nasal differences were not observed in the Class III group, nose and upper-lip deformities were common in the CLP groups. Upper-lip projection was reduced in all 3 groups. In the Class III patients, the lower lip and chin were more prominent than in the other groups. The facial convexity angle was increased in the CLP and Class III groups. The upper-lip volume was decreased in the BCLP, the UCLP, and the Class III groups. CONCLUSIONS Patients with skeletal Class III or CLP anomalies showed significantly different soft-tissue characteristics than the Class I control group. 3D stereophotogrammetric facial imaging is an easy and noninvasive method that can be used in examination and recording of these facial deformities. It is possible to make volumetric measurements using this method.

Influence of nasoalveolar molding on skeletal development in patients with unilateral cleft lip and palate at 5 years of age

INTRODUCTION

The aim of this retrospective study was to assess the influence of presurgical nasoalveolar molding (NAM) on skeletal development in patients with operated unilateral cleft lip and palate at 5 years of age.

MATERIALS

Lateral cephalometric radiographs of 26 unilateral cleft lip and palate patients who had undergone presurgical NAM (NAM group) and 20 unilateral cleft lip and palate patients who did not have any presurgical NAM (non-NAM group) were analyzed. The radiographs were digitally traced using Quick Ceph Studio software (version 3.5.1.r (1151); Quick Ceph Systems, San Diego, Calif). Independent samples t tests were performed for statistical analysis.

RESULTS

No significant differences were observed in sagittal and vertical skeletal measurements between the NAM and non-NAM groups.

CONCLUSIONS

NAM resulted in no significant difference in skeletal development in unilateral cleft lip and palate patients compared with those without NAM in early childhood.

Influence of Different Palatoplasties on the Facial Morphology of Early Mix Dentition Stage Children with Unilateral Cleft Lip and Palate

Objective

To compare the maxillofacial morphology in the early mixed dentition phase between two patient groups with unilateral cleft lip, alveolus, and palate who underwent different types of palatoplasty.

Design

Cross-sectional study.

Setting

An institutional study.

Patients and Interventions

Seventy-one patients with unilateral cleft lip and palate (UCLP) treated at Osaka University Dental Hospital, Japan, were divided into two groups: 33 patients were treated by early two-stage palatoplasty by the modified Furlow Technique (ETS), and 38 patients were treated by one-stage Wardill-Kilner push-back palatoplasty (PB). Intergroup comparisons were performed.

Main Outcome Measures

The dental, skeletal, and soft-tissue features were evaluated. For intergroup comparisons, Mann-Whitney U test was used for the statistical analyses.

Result

No significant differences existed between the ETS and PB groups regarding the skeletal features except for the mandibular ridge height. Meanwhile, the upper central incisor and upper lip of the ETS group showed a more anterior position than those in the PB group.

Conclusions

Early two-stage Furlow palatoplasty leads to more protruded upper lip, providing more anteriorly positioned upper incisors compared with PB, at least at the early mixed dentition stage.

Pediatric Obstructive Sleep Apnea: Consensus, Controversy, and Craniofacial Considerations

Pediatric obstructive sleep apnea, characterized by partial or complete obstruction of the upper airway during sleep, is associated with multiple adverse neurodevelopmental and cardiometabolic consequences. It is common in healthy children and occurs with a higher incidence among infants and children with craniofacial anomalies. Although soft-tissue hypertrophy is the most common cause, interplay between soft tissue and bone structure in children with craniofacial differences may also contribute to upper airway obstruction. Snoring and work of breathing are poor predictors of obstructive sleep apnea, and the gold standard for diagnosis is overnight polysomnography. Most healthy children respond favorably to adenotonsillectomy as first-line treatment, but 20 percent of children have obstructive sleep apnea refractory to adenotonsillectomy and may benefit from positive airway pressure, medical therapy, orthodontics, craniofacial surgery, or combined interventions. For children with impairment of facial skeletal growth or craniofacial anomalies, rapid maxillary expansion, midface distraction, and mandibular distraction have all been demonstrated to have therapeutic value and may significantly improve a child's respiratory status. This Special Topic article reviews current theories regarding the underlying pathophysiology of pediatric sleep apnea, summarizes standards for diagnosis and management, and discusses treatments in need of further investigation, including orthodontic and craniofacial interventions. To provide an overview of the spectrum of disease and treatment options available, a deliberately broad approach is taken that incorporates data for both healthy children and children with craniofacial anomalies.

Evaluation of mandibular hard and soft tissues in cleft patients

Purpose:

The aim of this study was to compare the mandibular hard and soft tissue measurements of unilateral and bilateral cleft lip and palate patients with non-cleft individuals.

Materials and Methods:

The study sample comprised of lateral cephalograms of 45 subjects. Sample included 15 non-cleft (NC), 15 unilateral cleft lip and palate (UCLP) and 15 bilateral cleft lip and palate (BCLP) cases whose age were between 15 to 17. 1 angular 13 linear measurements were carried out using Arnett and Gunson soft tissue cephalometric analysis and 4 angular measurements were calculated with Steiner Analysis.

Results:

Mandibular incisor inclinations relative to the occlusal plane (Md1-Md OP) were significantly greater and mandibular incisor projections (Md1-TVL) were significantly retrusive in cleft subjects (p<0.05). Projection values pertaining to lower lip anterior (LLA-TVL), soft tissue B point (B’-TVL), and soft tissue pogonion (Pog’-TVL) were significantly deficient as well in cleft patients (p<0.05). Sagittal position of the maxilla (SNA) (p<0.001) and intermaxillary relation of the jaws (ANB) were significantly deficient in UCLP subjects (p<0.05) and BCLP individuals (p<0.01). LLA-TVL and B’-TVL correlated with SNB in cleft patients (p<0.05).

Conclusion:

Decreased lower lip and chin projection values suggest that mandibular region of cleft patients should be taken into account in forming the treatment plan to improve the esthetic outcome of orthodontic and plastic surgery interventions.

Detailed Cleft Measurements: A Comparison between Isolated Cleft Palates and Cleft Palates Associated with Cleft Lips

Objective

To determine whether there are differences in the anatomical cleft measurements between patients with isolated cleft palate (CP) with or without Pierre Robin sequence (PR) and those with cleft lip and palate (CLP).

Design

Prospective case series.

Setting

Tertiary care university-based medical center.

Patients

From 1993 to 2012, CP and CLP patients were prospectively enrolled in a database.

Main Outcome Measures

Several anatomical cleft parameters were recorded with precise measurements at the time of palatoplasty under general anesthesia.

Results

One hundred twenty-five patients were included in our study: 50 patients in the CP without PR group, 87 patients in the CP with or without PR (CPPR) group, and 38 patients in the CLP group. Patients in the CLP group had increased values for the following parameters compared to patients with CP and patients with CPPR: nasopharyngeal depth ( P = .02 and P = .01, respectively); cleft width at posterior hard palate border ( P < .001 and P < .001); width of the dental arch ( P < .001 and P < .001); and total cleft length ( P < 01 and P < .001). For cleft width at the soft palate level, there was a significant difference between the CP and CLP groups ( P = .005). We found no statistically significant differences between the groups (CLP versus CP and CPPR, respectively) for the length of the soft palate ( P = .74, P = .21) or for the length of the hard palate ( P = .19, P = .08).

Conclusion

There are significant differences in cleft and palate measurements between CLP and CP patients that may be useful to predict the occurrence of velopharyngeal insufficiency or other complications.

Base of the skull morphology and Class III malocclusion in patients with unilateral cleft lip and palate

OBJECTIVE

The aim of the present study was to determine the morphological differences in the base of the skull of individuals with cleft lip and palate and Class III malocclusion in comparison to control groups with Class I and Class III malocclusion.

METHODS

A total of 89 individuals (males and females) aged between 5 and 27 years old (Class I, n = 32; Class III, n = 29; and Class III individuals with unilateral cleft lip and palate, n = 28) attending PUC-MG Dental Center and Cleft Lip/Palate Care Center of Baleia Hospital and PUC-MG (CENTRARE) were selected. Linear and angular measurements of the base of the skull, maxilla and mandible were performed and assessed by a single calibrated examiner by means of cephalometric radiographs. Statistical analysis involved ANCOVA and Bonferroni correction.

RESULTS

No significant differences with regard to the base of the skull were found between the control group (Class I) and individuals with cleft lip and palate (P > 0.017). The cleft lip/palate group differed from the Class III group only with regard to CI.Sp.Ba (P = 0.015). Individuals with cleft lip and palate had a significantly shorter maxillary length (Co-A) in comparison to the control group (P < 0.001). No significant differences were found in the mandible (Co-Gn) of the control group and individuals with cleft lip and palate (P = 1.000).

CONCLUSION

The present findings suggest that there are no significant differences in the base of the skull of individuals Class I or Class III and individuals with cleft lip and palate and Class III malocclusion.

Influence of modified Furlow double opposing Z-plasty on mandibular growth in Oriental patients with cleft palate and/or lip

The purpose of this study was to statistically analyze mandibular growth disturbance in the Oriental cleft population and compare this with that of non-cleft children through cephalometric analysis. Thirty-six children with cleft palates, repaired using a modification of Furlow double opposing Z-plasty, were chosen. Comparative analyses among 3 types of cleft were performed. Statistical analyses of 8 linear and angular measurements were performed in cleft patients and the non-cleft population using Fisher Z-transformation. Comparative analysis showed no significant difference among the 3 types of cleft. In the Oriental cleft group treated with modified double opposing Z-plasty, the spatial position of the mandible showed significant differences compared with the non-cleft group. A backward inclination of the anterior surface of the mandible and downward rotation of the mandibular body were identified. Some of our results regarding gonial angle and length of the mandibular body conflicted with previous Western studies.

Preoperative velopharyngeal morphology in older cleft palate patients with postoperative velopharyngeal closure versus velopharyngeal insufficiency

The purpose of this study was to investigate the preoperative morphology of velopharyngeal structures in older patients with cleft palate and to evaluate which structure(s) could distinguish velopharyngeal function. The investigators implemented a retrospective study and 66 patients whose palate was repaired by 1 surgeon with the same technique were selected, including 38 boys and 28 girls, aged from 5 years and 1 month to 28 years and 6 months. All these patients were taken lateral preoperative cephalograms at rest and during phonation of /i/. Fifteen lengths, 3 ratios, and 1 angle variable were defined in this study. The follow-up time was from 3 months to 12 months. All these measurements were analyzed by independent samples t test and discriminant analysis in a stepwise method, while P value was set at 0.05. In this study, there were 30 patients with velopharyngeal closure (VPC) and 36 patients with velopharyngeal insufficiency (VPI) after surgery. Differences in velar length, posterior velar length, pharyngeal height, hard-soft palatal angle, and pharyngeal height-depth ratio were significantly different at rest, while all the measurements during phonation were not significantly different. Discriminant analysis showed that the VPC group could be discriminated from the VPI group primarily on the basis of velar length, pharyngeal depth, and VP ratio, of which the correlation ratio was 0.963 and the discriminant rate was 100%. Therefore, the results suggested not only velar length and pharyngeal depth but also pharyngeal height significantly affected the formation of normal velopharyngeal function. Furthermore, there was a strong prognostic significance of preoperative velar length, pharyngeal depth, and VP ratio for postoperative velopharyngeal function.

A preliminary study on the characteristics of the velopharyngeal structures in different-age patients with cleft palate

The purpose of this study was to investigate the developmental tendency of velopharyngeal structures in different-age patients with cleft palate (CP) to provide reference for selecting surgery in clinic. The investigators implemented a retrospective study, and 66 patients were selected, including 38 boys and 28 girls (average age, 15 years 5 months ± 7 years). These patients were divided into 3 groups (G1, G2, and G3) according to their ages and were taken lateral preoperative cephalograms at rest and during phonation of /i/. Twelve lengths and 3 ratios variables were defined in this study. All these measurements were analyzed by analysis of variance and post hoc test, whereas P value was set at 0.05. There were significant differences of velar thickness and height, vertical velar length, pharyngeal height and depth, uvular pharyngeal depth, and hard palate length and height. Except velar height and vertical velar length of which the differences were only significant between G1 and G2, the difference of the others was significant between G1 and G2, and G1 and G3. In conclusion, velar thickness and posterior velar length increased significantly before 20 years old, whereas the motility of velar muscles between 12 years old and 20 years old was weaker. Growths of maxilla in vertical and horizontal dimension were faster before 20 years old. Besides, height-depth ratio was increasing with increase in age.

Craniofacial morphology in complete unilateral cleft lip and palate patients consecutively treated with 1-stage repair of the cleft

OBJECTIVE

To retrospectively evaluate the craniofacial morphology of children with a complete unilateral cleft lip and palate treated with a 1-stage simultaneous cleft repair performed in the first year of life.

METHODS

Cephalograms and extraoral profile photographs of 61 consecutively treated patients (42 boys, 19 girls) who had been operated on at 9.2 (SD, 2.0) months by a single experienced surgeon were analyzed at 11.4 (SD, 1.5) years. The noncleft control group comprised 81 children (43 boys and 38 girls) of the same ethnicity at the age of 10.4 (SD, 0.5) years.

RESULTS

In children with cleft, the maxilla and mandible were retrusive; the palatal and mandibular planes were more open, and sagittal maxillomandibular relationship was less favorable in comparison to noncleft control subjects. Soft tissues in patients with cleft reflected retrusive morphology of hard tissues--subnasal and supramental regions were less convex, profile was flatter, and nasolabial angle was more acute relative to those of the control subjects.

CONCLUSIONS

Craniofacial morphology after 1-stage repair was deviated in comparison with noncleft control subjects. However, the degree of deviation was comparable with that found after treatment with alternative surgical protocols.

Sagittal maxillary growth in children with unilateral cleft of the lip, alveolus and palate at the age of 10 years: an intercentre comparison

OBJECTIVE

Aim of this intercentre study was to compare sagittal facial growth in children with unilateral cleft lip and palate treated with different surgical protocols. A first evaluation had been carried out at the age of 6 years, now the patients have been re-evaluated at the age of 10 years.

MATERIAL AND METHOD

22 patients had been analyzed in centre 1, 32 patients in centre 2. All patients had presurgical orthopaedics. Centre 1 had lip repair at the age of 3 months and one-stage palatal closure with 1 year. Centre 2 had lip repair with 6 months, soft palate repair at 12 and hard palate repair at the age of 30 months. Sagittal growth was evaluated on lateral cephalograms. As control, data of 35 non-cleft children were used. Statistical analysis was carried out with student's t-test, multiple comparisons with Bonferroni.

RESULTS

There was considerably normal sagittal facial growth in centre 1, with tendency of forward growth of the mandible. In centre 2 there was a slight decrease in sagittal maxillary and mandibular growth with unchanged intergnathic relation. There was no statistically significant difference in sagittal growth between the centres. A re-evaluation has to be carried out after the final growth spurt.

Two-stage palate repair with delayed hard palate closure is related to favorable maxillary growth in unilateral cleft lip and palate

BACKGROUND

Two-stage palate repair with delayed hard palate closure is generally advocated because it allows the best possible postoperative maxillary growth. Nevertheless, in the literature, it has been questioned whether maxillary growth is better following use of this protocol. The authors therefore aimed to investigate whether stage of palate repair, one-stage versus two-stage, had a significant effect on facial growth in patients with unilateral cleft lip and palate.

METHODS

Seventy-two patients with nonsyndromic complete unilateral cleft lip and palate operated on by two different protocols for palate repair, one-stage versus two-stage with delayed hard palate closure, and their 223 cephalometric radiographs were available in the retrospective longitudinal study. Clinical notes were reviewed to record treatment histories. Cephalometry was used to determine facial morphology and growth rate. Generalized estimating equations analysis was performed to assess the relationship between (1) facial morphology at age 20 and (2) facial growth rate, and the stage of palate repair.

RESULTS

Stage of palate repair had a significant effect on the length and protrusion of the maxilla and the anteroposterior jaw relation at age 20, but not on their growth rates.

CONCLUSIONS

The data suggest that in patients with unilateral cleft lip and palate, two-stage palate repair has a smaller adverse effect than one-stage palate repair on the growth of the maxilla. This stage effect is on the anteroposterior development of the maxilla and is attributable to the development being undisturbed before closure of the hard palate (i.e., hard palate repair timing specific).

Dental arch relationship in children with complete unilateral cleft lip and palate following one-stage and three-stage surgical protocols

The objective of this study is to compare dental arch relationship following one-stage and three-stage surgical protocols of unilateral cleft lip and palate. Dental casts of 61 children (mean age, 11.2 years; SD, 1.7), consecutively treated in one center with one-stage closure of the complete cleft at 9.2 months (SD, 2.0), were compared with a sample of 97 patients (mean age, 8.7 years; SD, 0.9), consecutively treated with a three-stage protocol including delayed hard palate closure in another center. The dental casts were assigned random numbers to blind their origin. Four raters graded dental arch relationship and palatal morphology using the EUROCRAN index. The strength of agreement of rating was assessed with kappa statistics. Independent t tests were run to compare the EUROCRAN scores between one-stage and three-stage samples, and Fisher's exact tests were performed to evaluate differences of distribution of the EUROCRAN grades. The intra- and inter-rater agreement was moderate to very good. Dental arch relationship in the one-stage sample was less favorable than in three-stage group (mean scores, 2.58 and 1.97 for one-stage and three-stage samples, respectively; p < 0.000). Palatal morphology in the one-stage sample was more favorable than in the three-stage group (mean scores, 1.79 and 1.96 for one-stage and three-stage samples, respectively; p = 0.047). The dental arch relationship following one-stage repair was less favorable than the outcome of three-stage repair. The palatal morphology following one-stage repair, however, was more favorable than the outcome of three-stage repair.

Dental Arch Relationship in Children with Complete Unilateral Cleft Lip and Palate following Warsaw (One-Stage Repair) and Oslo Protocols

Objective:

To compare the dental arch relationship following one-stage repair of unilateral cleft lip and palate (UCLP) in Warsaw with a matched sample of patients treated by the Oslo Cleft Team.

Material:

Study models of 61 children (mean age, 11.2; SD, 1.7) with a nonsyndromic complete UCLP consecutively treated with one-stage closure of the cleft at 9.2 months (range, 6.0 to 15.8 months; SD, 2.0) by the Warsaw Cleft Team at the Institute of Mother and Child, Poland, were compared with a sample drawn from a consecutive series of patients with UCLP treated by the Oslo Cleft Team and matched for age, gender, and soft tissue band.

Methods:

The study models were given random numbers to blind their origin. Four examiners rated the dental arch relationship using the GOSLON Yardstick. The strength of agreement of rating was assessed with weighted Kappa statistics. An independent t-test was carried out to compare the GOSLON scores between Warsaw and Oslo samples, and Fisher's exact tests were performed to evaluate the difference of distribution of the GOSLON scores.

Results:

The intrarater and interrater agreements were high (K ≥ .800). No difference in dental arch relationship between Warsaw and Oslo groups was found (mean GOSLON score  =  2.68 and 2.65 for Warsaw and Oslo samples, respectively). The distribution of the GOSLON grades was similar in both groups.

Conclusions:

The dental arch relationship following one-stage repair (Warsaw protocol) was comparable with the outcome of the Oslo Cleft Team's protocol.

Treatment Outcome after One-Stage Repair in Children with Complete Unilateral Cleft Lip and Palate Assessed with the Goslon Yardstick

Objective:

To compare results of Golson Yardstick measurement of dental arch relationships in a sample of 10-year-old Polish children with results of the Golson measurement in published reports.

Materials and Methods:

Plaster models of 28 consecutively treated subjects with unilateral cleft lip and palate (UCLP) that was repaired with a one-stage simultaneous closure performed in the first year of life. All individuals were born between 1994 and 1995. The Goslon score (categories 1 to 5) was allocated. Intra- and interrater agreement was assessed with kappa statistics and Pearson correlation coefficient. Independent t tests were employed to detect difference between the score in the present and other published samples.

Results:

Mean Goslon score equaled 2.44; 57% of the patients were allocated Goslon category 1 or 2, 32% were rated Goslon 3, and 11% of the patients were assigned category 4 or 5. Intrarater agreement was between 0.75 and 0.77. Interrater agreement was 0.79.

Conclusions:

Dental arch relationship following one-stage repair was comparable with the results of the centers with the best outcome.

The effect of Delaire cheilorhinoplasty on midfacial growth in patients with unilateral cleft lip and palate

The aim of this research was to evaluate the effect of the Delaire surgical technique on the midfacial morphology in a group of subjects with a congenital unilateral cleft of lip and palate (UCLP), prior to orthodontic treatment. Thirty-five UCLP (15 left and 20 right) patients (16 males and 19 females, mean age 7.03+/-0.9 years; age range 8.7-5.0 years), treated for the correction of congenital malformation, were retrospectively selected. Analysis of midfacial growth was undertaken on lateral cephalograms, and the data were compared with reference values (Ricketts analysis). A Mann-Whitney ranked sum test was used to detect significant differences between the findings and reference values. P <or= 0.05 was considered as significant. The results demonstrated a retropositioning of both the maxilla and mandible (SNA and SNB P<0.01) and increased mandibular development (Go-Me distance). Vertically, there was a trend to a posterior rotation of the mandible (P<0.01), resulting in a hyperdivergent profile. This trend was confirmed by the increase in SpA-SpP/Go-Me (P<0.05). In agreement with previous studies, the effects of surgical closure of a cleft lip might be responsible for excessive maxillary retropositioning with a downward rotation.

Midfacial Growth in a Consecutive Series of Preadolescent Children with Complete Unilateral Cleft Lip and Palate following a One-Stage Simultaneous Repair

Objective:

To evaluate midfacial growth in prepubertal children with complete unilateral cleft lip and palate following one-stage simultaneous repair.

Subjects:

A series of 28 consecutively treated subjects with complete unilateral cleft lip and palate were compared with age- and gender-matched controls with normal midfacial structure.

Methods:

On the lateral cephalograms taken at the age of approximately 10 years, size and position of the maxilla and upper dental arch were evaluated in vertical and horizontal planes. Statistical analysis included independent t tests and nonparametric Mann-Whitney tests.

Results:

The maxilla was found to be retruded (sella-nasion-point A angle decreased by 4.5° and nasion to point A distance increased by 4.2 mm) and rotated posteriorly (sella-nasion/palatal plane angle decreased by 4.5°) in the cleft group. Maxillary length (pterygomaxillare-point A distance) was diminished by approximately 2 mm. Upper incisors were found retroclined in comparison to controls (both upper incisor axis/sella-nasion and upper incisor axis/palatal plane angles were decreased by 10.7° and 6.1°, respectively).

Conclusion:

Maxillary prominence, as measured with the sella-nasion-point A angle and the condylion-point A and articulare-point A distances, was decreased. Shortened length and posterior position of the maxillary body were responsible at a ratio of 60% to 40% for a decreased prominence of the maxillary complex. The palatal plane demonstrated a larger inclination to the sella-nasion plane by 4.5° due to a decreased sella-posterior nasal spine distance.