Occlusal relationship in patients with bilateral cleft lip and palate during the mixed dentition stage: does neonatal maxillary arch configuration predetermine outcome?

Analysis of treatment methods for children with bilateral complete cleft of the lip and palate in mixed bite

Relevance. According to the World Health Organization, it was found that cleft lip and palate cases ranges from 0.6 to 1.6 cases per 1000 newborns. According to the severity of the lesion, bilateral cleft lip and palate takes the first place, however, it occurs much less common – 15-25%.

Purpose – to analyze methods of treatment in children with bilateral cleft lip and palate during the period of the mixed dentition.

Materials and methods. An analysis of 51 sources Russian and foreign articles for the period from 1951 to 2019 was carried out. The features of the development of occlusion in children with bilateral cleft lip and palate during the period of a changeable occlusion, as well as methods of treating this pathology, are considered.

Results. It was found that the main anatomical features of the maxillofacial region in children with bilateral cleft lip and palate during the period of a changeable bite are -narrowing of the upper and lower jaws, the presence of soft tissue scars. The main methods of treatment for such children are reconstructive surgery, including the closure of a hard palate defect using a mucoperiosteal flap cut out in the lateral part of the hard palate, as well as orthodontic treatment methods, the main purpose of which is to expand and extend the dentition using single jaw removable plate apparatuses, fixed plate apparatuses.

Conclusions. Taking everything into account, surgical reconstructive operations, as well as complex orthodontic treatment, the main purpose of which is to expand and extend the upper and lower jaws, are the integral methods of treating such children. Orthodontic treatment should be aimed at eliminating myofunctional disorders with the helpof orthodontic trainers and elastopositioners. Conducting a comprehensive surgical and orthodontic treatment can reduce the rehabilitation time of children with bilateral cleft lip and palate.

Craniofacial Morphology in Children with Complete Bilateral Cleft Lip and Palate: Does Infantile Size of the Premaxilla Predetermine Outcome?

Objective

To evaluate the possible association between the size of the premaxilla in infants and craniofacial morphology in children with complete bilateral cleft lip and palate (CBCLP) and identify the characteristics of craniofacial morphology in children with CBCLP with median facial dysplasia (MFD).

Design

Retrospective study.

Setting

A university hospital craniofacial center.

Subjects

Thirty-four patients with nonsyndromic CBCLP, 24 boys and 10 girls, had large premaxilla (LP group). Thirty-six patients with nonsyndromic CBCLP, 16 boys and 20 girls, had small premaxilla (SP group). Thirteen CBCLP patients with MFD, five boys and eight girls (MFD group).

Main Outcome Measures

Infant maxillary dental cast at the age of 1 year was used to measure the size of the premaxilla. Cephalometric analysis was used to determine craniofacial morphology in children at the age of 5 years.

Results

The size of the premaxilla in infants with CBCLP varied greatly. The LP group tended to have a longer maxilla and a more protruded maxilla, producing a better interjaw relation. The opposite phenomena were observed in the MFD group; the SP group yielded results between those of the LP and the MFD groups.

Conclusion

The size of the premaxilla in infants with CBCLP can be used to predetermine subsequent craniofacial morphology at the age of 5 years. Children with nonsyndromic CBCLP had craniofacial characteristics that differed significantly from those of children with CBCLP with median facial dysplasia.

Premaxillary characteristics in complete bilateral cleft lip and palate: A predictor for treatment outcome

Objectives:

The aim of the current study was to investigate how bilateral cleft lip and palate (BCLP) cases responded differently to presurgical orthopedics (PSO) and primary lip repair (LR) based on premaxillary characteristics. We suggest a clinically oriented descriptive classification for BCLP based on premaxillary characteristics.

Design and Setting:

A retrospective longitudinal comparative study where available records of all non-syndromic patients with complete BCLP attending the Cleft Clinic, affiliated to the Oral and Maxillofacial Surgery department, Ain-Shams University, Cairo, Egypt were assessed.

Sample Population and Methodology:

Twenty-two cases were collected over a 4-years period from 2008 to 2011 (15 boys and 7 girls). Model assessment was performed for serial models representing four stages of treatment; M1: Prior to start of PSO, M2: At the end of PSO, M3: One month after LR, M4: Three months after LR. The premaxillary and vomerine widths were measured on M1. Models (M1-M4) were assessed for changes in anteroposterior projection, anterior arch width, intercanine width and posterior arch width and results were statistically analyzed. Intra-and postoperative surgical findings during and after primary LR were recorded. The sample was divided into two groups based on the premaxillary size and characteristics; Group R: Rudimentary premaxilla and Group P: Prominent premaxilla.

Results:

There was a highly significant difference in premaxillary width between the two groups (P = 0.00), changes in anteroposterior projection of the premaxilla were significant one and three months after LR. Changes in maxillary anterior arch width, intercanine and posterior arch widths were non-significant between groups. Mean age difference between the two groups was only statistically significant at the stage of LR. Surgical differences were noted between the two groups. Postoperatively as compared to group R; group P showed more premaxillary bulge and show at rest, as well as more prolabial stretching. In addition, facial profile was more convex in group P.

Conclusion:

The two types of BCLP outlined in this study are different from several aspects, and hence management should be modified according to each case. This descriptive classification provides a useful tool for evaluation and planning of patients with BCLP.

A Longitudinal Three-Center Study of Dental Arch Relationship in Patients with Bilateral Cleft Lip and Palate

Objective

To compare and evaluate longitudinally the dental arch relationships from 4.5 to 13.5 years of age with the Bauru-BCLP Yardstick in a large sample of patients with bilateral cleft lip and palate (BCLP).

Design

Retrospective longitudinal intercenter outcome study.

Patients

Dental casts of 204 consecutive patients with complete BCLP were evaluated at 6,9, and 12 years of age. All models were identified only by random identification numbers.

Setting

Three cleft palate centers with different treatment protocols.

Main Outcome Measures

Dental arch relationships were categorized with the Bauru-BCLP yardstick. Increments for each interval (from 6 to 9 years, 6 to 12 years, and 9 to 12 years) were analyzed by logistic and linear regression models.

Results

There were no significant differences in outcome measures between the centers at age 12 or at age 9. At age 6, center B showed significantly better results ( p = .027), but this difference diminished as the yardstick score for this group increased over time (linear regression analysis), the difference with the reference category (center C, boys) for the intervals 6 to 12 and 9 to 12 years being 10.4% ( p = .041) and 12.9% ( p = .009), respectively.

Conclusions

Despite different treatment protocols, dental arch relationships in the three centers were comparable in final scores at age 9 and 12 years. Delaying hard palate closure and employing infant orthopedics did not appear to be advantageous in the long run. Premaxillary osteotomy employed in center B appeared to be associated with less favorable development of the dental arch relationship between 9 and 12 years.