Post-surgical effects on the maxillary segments of children with oral clefts: New three-dimensional anthropometric analysis

This study aimed to use new three-dimensional (3D) anthropometric analyses to verify the post-surgical effects on the maxillary segments of children with unilateral cleft lip and palate. The sample was composed by digitized dental models of 60 children with unilateral complete cleft lip and alveolus (UCLA) and complete unilateral cleft lip and palate (UCLP). The impressions were taken before cheiloplasty (T1), after cheiloplasty (T2), and after palatoplasty (T3). The 3D anthropometric analyses of digitized dental casts were obtained through a specific software. Intragroup changes were applied paired t test and Wilcoxon test (UCLA group) and for the UCLP group, repeated-measures analyses of variance followed by the Tukey test. For intergroup analyses, an independent t test and Mann–Whitney test were used. The palatal dimensional changes of UCLA group showed that the distances IC, I?T′, and I–T significantly increased after cheiloplasty (p = 0.0002, p = 0.0007 and p < 0.0001, respectively). In the UCLP group, the IC′ distance statistically decreased in the post-surgical periods (p < 0.0001), while the I–T distance increased (p < 0.0001). The IC distance increased after cheiloplasty (p < 0.0001). The I?T′ distance increased between T2 and T3 with statistically significant differences (p = 0.0037). The intergroup analysis of palatal development (T2-T1) showed that the distances IC′ and I–T′ demonstrated a reduction of the dental arches growth of UCLP group compared with the UCLA group, with statistically significant differences. The new 3D anthropometric analysis showed that the development of the maxillary segments changed after surgical repair. The UCLP group demonstrated a reduction of the dental arches growth compared with the UCLA group.     

Development of the residual cleft in the hard palate after velar repair in a 2-stage palatal repair regimen

Delayed closure of the hard palate is believed to improve maxillary growth and facial appearance in cleft lip and palate patients. However, the cleft opening in the hard palate after velar closure might impair speech development. The aim of this investigation was to study the development of the residual cleft in the hard palate after 2-stage palatal repair (TSPR) in children born with complete cleft lip and palate (bilateral [BCLP]; n=7 or unilateral [UCLP]; n=22) or isolated cleft palate (CP; n=9). Moreover, we aimed to investigate whether any morphologic factors before surgery might predict development of the residual cleft. Dental casts obtained prior to velar repair (mean age 7 months) and postoperatively at 1 1/2, 3, 4, 5 and 7 years were analyzed with a Reflex Microscope regarding the width, length and area of the cleft in the hard palate.The palatal cleft varied in size both pre- and postoperatively in all 3 types of cleft patients. The width of the cleft in the UCLP subgroup showed a marked reduction immediately after velar repair, but then, on average, remained stable until final surgical closure of the hard palate. In the BCLP subgroup the initially rather narrow width of the clefts remained unchanged postoperatively. Clefts in the CP subgroup, especially in those with a complete cleft, remained large after veloplasty. In 4 of the UCLP and 2 of the BCLP patients, the cleft width increased gradually. In some other subjects, both in the UCLP and BCLP subgroups, the residual cleft closed functionally with time, but this development could not be foreseen.     

Relationship between primary palatal form and maxillofacial growth in Japanese children with unilateral cleft lip and palate: infancy to adolescence.

OBJECTIVE: The purpose of this retrospective study was to evaluate the relationship between the severity of maxillary defects and maxillofacial growth from infancy to adolescence in children with complete unilateral cleft lip and palate (UCLP). SUBJECTS: Thirty-one Japanese children with UCLP who had received cheiloplasty, palatoplasty, and orthodontic treatments at the Kyushu University Dental Hospital were selected. MATERIALS AND METHODS: A three-dimensional laser scanner was used to measure maxillary dental casts taken at cheiloplasty. Surface areas and volumes of the palatal tissue were calculated. Lateral cephalographs that were taken both at cheiloplasty and 15 years of age or over (average age 16.5 years) were traced and digitized. Angular and linear measurements were calculated from the x, y-coordinates. Using correlation analyses, defects in the palatal tissue were compared with maxillofacial morphology both at cheiloplasty and in adolescence or maxillofacial growth during that time span. RESULTS: (1) The surface areas or volumes of the palatal tissue were significantly correlated with the following maxillofacial measurements at infancy and adolescence: Or-depth; A-depth; PNS-height; ANS-height; N-Ba; S-N; S-Ba; N to P.P.; A'-Ptm'; Cd-Pog; Cd-Gn; Cd-G; and the N-S-Ba, S-N-A, and A-N-B angles. (2) They were also significantly correlated with the following maxillofacial growth measures from infancy to adolescence: A-depth, S-Ba, and the N-S-Ba and S-N-A angles. Only the N-S-Ba angle showed a negative correlation. CONCLUSION: The patient who had more palatal tissue at cheiloplasty showed better maxillofacial growth.     

唇腭裂患者与安氏I类错牙合患者上颌骨发育比较

目的：探讨唇腭裂患者与安氏I类错牙合患者上颌骨发育的差异。方法：选取单侧完全性唇腭裂（complete unilateral cleft lip and palate,UCLP）50例、单侧完全性唇裂（complete unilateral cleft lip,UCL）28例,按不同颈椎骨龄分期分为3组,将其与相同发育期的安氏I类患者头影测量数据进行比较。结果：在所有发育期,UCLP的SNA（°）ANB （°）U1－U6（mm）均较安氏I类错牙合者小。CS1－6期结果显示：UCLP的SNA（°）ANB（°）U1－U6均值分别较安氏I类错牙合者小7．07°、4．05°、5．56 mm,SN－PP（°）均值较安氏I类错牙合者大3．98°。UCLP患者ANS－PNS（mm）、U1－PP（mm）等随发育较安氏I类错牙合者逐渐减小的趋势;结论：UCLP患者较安氏I类错牙合上颌位置靠后,上颌矢状向长度不足,腭平面顺时针旋转,上前牙舌倾。UCL患者上颌骨大小及位置与安氏I类错牙合相似。     

Comparison between the palatal configurations in complete and incomplete unilateral cleft lip and palate infants under 18 months of age.

OBJECTIVE: The purpose of this study was to examine the three-dimensional characteristics of the palatal configurations in incomplete unilateral cleft lip and palate (UCLP) patients and to determine whether there are differences in the effect of early orthopedic treatment between complete and incomplete UCLP patients. DESIGN: Eight infants with incomplete UCLP and 12 infants with complete UCLP, selected at random, wore Hotz plates, and 8 other infants with complete UCLP did not. Palatal impressions were taken of these patients immediately after birth and at 1, 2, 3, 4 (just before cheiloplasty), 6, and 18 months of age (just before palatoplasty). Using our measuring system, the palatal casts were measured and compared three-dimensionally. RESULTS AND CONCLUSIONS: The palate of the incomplete UCLP patients measured immediately after birth, compared with complete UCLP, showed: (1) smaller posterior arch width; (2) sagittal arch length did not differ; (3) incisal point was located more mesially; (4) the gap between the alveolar arch forms of the major and minor segments was smaller; and (5) the curvature of the palatal surface forward the nasal cavity in the minor segment was less. At 18 months of age, the following characteristics could be observed: (1) the difference observed at birth in the posterior arch width between the incomplete and complete UCLP infants vanished; (2) a significant difference in the location of the incisal point was observed only between the incomplete UCLP infants and the complete UCLP infants with a Hotz plate; and (3) the curvature was less in the incomplete UCLP infants than in the complete UCLP infants. Furthermore, the morphological change of the palatal surface was less in the incomplete UCLP infants than in the complete UCLP infants. This suggested that any influence of the Hotz appliance might be less in incomplete UCLP than in complete UCLP.     

Evaluation of the intercanine distance in newborns with cleft lip and palate using 3D digital casts

Objective

The purpose of this present study was to compare, by means of 3D digital casts, the anterior transverse dimension of the dental arch of newborns with and without cleft lip and palate.

Material and Methods

The sample was composed of ninety-four children aged from 3 to 9 months divided into three study groups: Group I - children without craniofacial deformities (control group); Group II - children with unilateral cleft lip and palate; Group III - children with bilateral cleft lip and palate. Impressions were executed before lip and palate repair in patients with clefts. Dental casts were digitized using a 3D scanner linked to a computer. Measurements of the intercanine distance were measured on the digital casts. Intergroup comparisons were performed using ANOVA (p<0.05).

Results

The results showed a mean of 36.5 mm for unilateral cleft lip and palate group, 34.8 mm for bilateral cleft lip and palate group and 27.52 mm for the control group. There was a statistically significant difference between the control group and both groups of patients with cleft lip and palate. There was no statistically significant difference between complete unilateral and bilateral cleft lip and palate groups.

Conclusions

Patients with complete cleft lip and palate were born with an increased anterior dimension of the maxillary dental arch compared to non cleft patients.     

单侧完全性唇腭裂患儿术前正畸及手术前后的上腭裂隙变化

目的 探讨单侧完全性唇腭裂患儿术前正畸及手术前后的上腭裂隙变化.方法 对18例单侧完全性唇腭裂患儿先用上颌腭托矫治器(PNAM)术前正畸治疗后,再进行唇裂修补手术.采用模型测量方法,比较患儿初诊时、手术前1个月和手术后2个月时的上腭裂隙变化.结果 治疗后患儿唇部外形明显改善,腭部裂隙减小,患侧塌陷的鼻翼穹隆高度恢复.结...     

唇裂修复术对上颌骨生长发育影响的初步探讨

目的：进一步了解唇裂修复手术对唇裂伴牙槽突裂和唇腭裂患者上颌骨生长发育影响方面的差异及其机制,方法：将84例唇裂修复术后患者分为唇裂伴牙槽突裂、唇腭裂唇裂修复组和唇腭裂均修复组,并设健康对照组,摄定位头颅线片并测量分析。结果：唇裂修复术对唇腭裂组上凳骨生长发育的影响明显大于唇裂伴牙槽突裂组,结论：唇腭裂的裂与组织缺损是导致唇裂修复影响上颌骨生长的重要原因。     

Nasalance measures in German-speaking cleft patients

The purpose of this study was to evaluate nasalance measures in German-speaking patients with different types of repaired cleft lip and palate and to find out if significant nasalance gender differences exist in the different cleft groups. A total of 125 German-speaking cleft patients (74 male and 51 female) were included in this study: 18 patients with isolated unilateral cleft lip (UCL; mean age: 13.00 +/- 2.03 years), 66 patients with complete unilateral cleft lip and palate (UCLP; mean age: 14.80 +/- 3.45 years), 25 patients with isolated cleft palate (CP; mean age: 14.60 +/- 3.48 years), and 16 patients with complete bilateral cleft lip and palate (BCLP; mean age: 14.30 +/- 3.61 years). Nasalance data were collected and computed using the NasalView hardware/software system (Fa. Tiger Electronics, Seattle, WA). Speech stimuli according to a modified Heidelberg Rhinophonia Assessment Form (sustained vowels "a," "e," "i," "o," and "u"; oral and nasal sentences; and three oral-nasal reading passages) were used to obtain nasalance scores. Nasalance distance and ratio were also calculated for the oral and nasal sentences and for one of the oral-nasal reading passages. Unpaired t tests showed no significant gender nasalance differences in each cleft group. Analysis of variance showed no significant differences in mean nasalance distance and ratio. For the nasal sentence, a significant difference (P = 0.032) in mean nasalance scores was found between the UCL and UCLP groups.     

Bite force of children with repaired unilateral and bilateral cleft lip and palate

ObjectiveTo assess the bite force (BF) of children with repaired cleft lip and palate (CLP).DesignChildren aged 6–12 years, with and without CLP, were divided into the following 5 groups: (1) control group (CON): 34 children without CLP (17 female, 17 male, mean age 8.2 ± 1.4); (2) cleft lip group (CL): 31 children with cleft lip involving the pre-maxilla (15 female, 16 male, mean age 9.7± 1.3); (3) unilateral CLP group (UCLP): 36 children with complete unilateral CLP (11 female, 25 male, mean age 9.4± 1.6); (4) bilateral CLP group (BCLP): 32 children with complete bilateral CLP (11 female, 21 male, mean age 9.5± 1.7); and 5) cleft palate group (CP): 17 children with complete cleft palate (9 female, 8 male, mean age 9.4± 1.6). Briefly, in this clinical trial, BF was assessed before alveolar bone grafting with a gnathodynamometer (IDDK, Kratos, Cotia, SP, Brazil). For CON, BCLP, CL and CP groups, BF was obtained in the anterior and posterior region of the maxilla. For the UCLP group, BF was assessed in the anterior and posterior regions of both segments. Differences among groups were evaluated by ANOVA test, and Tukey’s test was used to assess any correlations among variables (P < 0.05).ResultsUnexpectedly, no differences of BF were observed among CON and any of the cleft groups. However, a stronger BF was observed in the CL group when compared to the UCLP and BCLP groups. Next, no differences were observed between the cleft side and the noncleft side in the UCLP group. Lastly, in all groups, BFs from the anterior region of the maxilla were less when compared to the posterior regions.ConclusionThe BF of children with CLP is no different from children without CLP.     

Initial growth pattern of children with cleft before alveolar bone graft stage according to cleft type: Unilateral cleft lip and alveolus,unilateral cleft lip and palate,and cleft palate

Objective:To test the null hypothesis that there is no significant difference in the initial growth pattern among three cleft types before alveolar bone graft (ABG) according to cleft type (unilateral cleft lip and alveolus [UCLA], unilateral cleft lip and palate [UCLP], and cleft palate [CP]).Materials and Methods:Samples consisted of the UCLA group, the UCLP group, and the CP group. Individuals were treated with the identical surgical technique by the same surgeon and had no history of orthodontic/orthopedic treatment. Lateral cephalograms taken 1 month before ABG were analyzed using 29 variables. One-way analysis of variance (ANOVA) testing and bivariate and logistic regression analyses were performed.Results:An increasing tendency for Class III relationships in the order of UCLA, UCLP, and CP was noted (ANB, AB-to-facial plane angle, AB-to-mandibular plane angle; P < .001, respectively). UCLP and CP groups demonstrated more posterior positioning of the maxilla (SNA, A-to-N-perp; P < .001, respectively) and a hyperdivergent pattern (gonial angle, SN-GoMe angle, FMA; P < .001, respectively) compared with the UCLA group. Because no differences in palatal plane angle and SN-to-occlusal plane angle were noted among the three groups, the hyperdivergent pattern in the UCLP and CP groups might be due to an innate growth pattern and eventual adaptation of the mandible to maxillary growth. UCLP and CP groups showed more Class III relationships (ANB: P < .05, P < .001, respectively) and a more hyperdivergent pattern (FMA: P < .05, P < .01, respectively) than the UCLA group.Conclusion:When the degree of cleft involvement increases from the primary palate to the secondary palate, the predominance of the Class III relationship and the hyperdivergent pattern increases also.     

Early assessment of dental arch development in repaired unilateral cleft lip and unilateral cleft lip and palate versus controls.

OBJECTIVE: To evaluate dental arch relationships and dimensions, relative to an age matched noncleft sample, in Caucasian 3-year-old children with repaired unilateral cleft lip (UCL) or unilateral cleft lip and palate (UCLP). DESIGN: Prospective, cross-sectional, case-control study performed in Scotland, U.K. PARTICIPANTS: Eleven children with repaired unilateral cleft lip, 16 children with repaired unilateral cleft lip and palate, and 78 children as controls. MAIN OUTCOME MEASURES: Dental arch relationships and linear arch dimensions. RESULTS: Prevalence of Class III incisor relationship was 31.3% in children with unilateral cleft lip and palate compared with 9.1% in children with unilateral cleft lip. A buccal crossbite was present in 36% of children with unilateral cleft lip, compared with 75.6% of children with unilateral cleft lip and palate.Mean linear maxillary arch dimensions did not differ significantly between children with unilateral cleft lip and the controls. Except for second intermolar width, statistically significant differences existed in mean linear maxillary arch dimensions between the unilateral cleft lip and the unilateral cleft lip and palate groups; the mean linear maxillary arch dimensions were significantly greater in the control group than in the unilateral cleft lip and palate group. The mean cleft-affected anterior quadrant length appeared to be the arch dimension with the greatest power of discrimination among the three groups. There were no significant differences in mean linear mandibular arch dimensions among the three groups. CONCLUSIONS: Anterior crossbite was almost three times more common in the unilateral cleft lip and palate group than in the unilateral cleft lip group. Mean linear maxillary arch dimensions differed significantly between the unilateral cleft lip and palate group and the control group. There were no significant differences in mean linear maxillary arch dimensions between unilateral cleft lip and controls or between mean linear mandibular arch dimensions for unilateral cleft lip, unilateral cleft lip and palate, and controls.     

Facial characterization of infants with cleft lip and palate using a three-dimensional capture technique.

OBJECTIVE: To characterize the soft tissue features of infants with unilateral cleft lip (UCL) and unilateral complete cleft lip and palate (UCLP) prior to primary surgery and compare with noncleft controls. DESIGN: Prospective controlled capture of the facial morphology of infants using a noninvasive three-dimensional stereophotogrammetry method. PARTICIPANTS: 23 children with presurgical cleft: 11 UCL (M = 6, F = 5); 12 UCLP (M = 9, F = 3), and 21 noncleft controls (M = 7, F = 14) were imaged at approximately 3 months of age (range 10 to 16 weeks). MAIN OUTCOME MEASURE: Accurate, repeatable quantification of facial soft tissues in infants with clefts prior to surgery. RESULTS: Significant differences (p <.05) were found between the UCLP group and UCL and control groups in anatomical and soft nose width, cleft-side alar wing length, and nasal tip horizontal displacement. Both cleft groups were significantly different from controls and from each other in cleft-side nostril dimensions, alar wing angulation, columella angle, and alar base to corner of mouth dimension; alar base width; and soft tissue defect in nose and the lip and philtrum length bordering the cleft. Significant differences between clefts and controls were identified in the nostril and philtrum on the noncleft side. CONCLUSIONS: The use of children with UCL as controls for UCLP studies is inappropriate. This technique overcame the limitations of direct measurement of infant faces to aid the surgeon in the planning and subsequent re-evaluation of surgical rationale.     

The Incidence of Cleft Lip and Palate in Northern Ireland from 1980–1990

Abstract

This study reports the incidence of the various types of cleft lip and/or palate drawn from a regional database of all affected children born in Northern Ireland during the period 1980–1990. The incidence of these anomalies was 1·28 per 1000 live births (1:781).

Fifty-three per cent of clefts involved the secondary palate only, 16 per cent the primary palate only, 26 per cent involved both primary and secondary palate, and 5 per cent were unconnected.

Overall, more males than females were affected and there were more males than females in the group having complete clefts. Separate clefts of lip and palate occurred exclusively in males with only one exception.

Unilateral clefts were more common on the left side.

Within the group showing complete unilateral cleft of the primary and secondary palate, left-sided clefts were more commonly male, right-sided clefts were more commonly female.

There were no statistically significant sex differences between sides in the unilateral primary palate cleft group.     

成人腭裂患者腭盖表面积和倾斜度的比较研究

目的:观察腭裂患者上颌骨是否具有正常的生长发育潜能.方法:应用三维CT扫描成像系统,对比分析正常(牙合)成人、单侧完全性唇腭裂均已手术修补组以及腭裂未手术修补组成人患者的腭盖表面积和倾斜度.结果:腭裂未手术组的腭盖倾斜度显著高于正常对照组,腭盖向颅侧旋转,位置更加垂直;无论腭裂手术修补与否,腭裂患者的腭盖面积均显著小于正常对照组.结论:单侧完全性腭裂患者存在内在性的组织发育不足.     

Cephalometric analysis of maxillofacial morphology in unoperated cleft palate patients.

This study was designed to investigate maxillofacial morphology in adolescents and adults with unrepaired cleft palate, with or without cleft lip. Twenty-two Chinese patients with unilateral cleft lip and palate (the UCLP group), and 21 Chinese with cleft palate (the CP group) were cephalometrically evaluated and classified into the five ranges established from the means and standard deviations for matched normal Chinese populations. Many subjects in both UCLP and CP groups showed an intrinsic maxillary retrusion and a steeper mandible. The others had nearly normal maxillofacial morphology. The tendency for maxillary retrusion and a steeper mandible became increasingly remarkable with age. In the long axis of upper incisors in subjects with permanent dentition, there were no UCLP subjects with labial inclination, whereas three CP subjects exhibited labial inclination.     

A longitudinal study on influence of primary facial deformities on maxillofacial growth in patients with cleft lip and palate.

OBJECTIVE: The goal of this study was to use three-dimensional (3D) analysis to characterize the primary facial deformities in children with unilateral cleft lip and palate (UCLP) and then serially analyze the relationships between facial deformities and maxillofacial growth from infancy to adolescence. PARTICIPANTS: Twenty-one Japanese subjects with unilateral cleft lip and alveolus (UCLA) and 20 with UCLP who had been operated on and then followed up for more than 15 years were enrolled in this study. MAIN OUTCOME MEASURES: Facial cast models taken at cheiloplasty were scanned with a 3D laser scanner. Lateral cephalographs taken when subjects were 15 years of age or older were traced, and linear and angular measurements were calculated. The correlation between primary facial forms and maxillofacial morphology in adolescence was analyzed. RESULTS: Three-dimensional analysis showed larger ocular hypertelorism, wider cleft, greater deviation of the columella base, and more severe retruded position of the affected nasal alar base in subjects with UCLP than those with UCLA. Total surface area of the upper lips in subjects with UCLP was significantly smaller than those with UCLA. Correlation analyses revealed that the width of cleft lip, deviation of the columella base, difference of the nose base width, and surface area of the upper lip were statistically correlated with the maxillary length, the anterior position of the maxillary alveolar base, the posterior facial height, and the high angle of the mandible. CONCLUSION: The subjects who had less severe facial deformities and more tissue volume of the upper lips at cheiloplasty showed better maxillofacial growth.     

Changes in soft tissue thickness after Le Fort I osteotomy in different cleft types

The soft tissue thickness before and after Le Fort I osteotomy was evaluated in 46 cleft patients. The sample consisted of 10 patients with isolated cleft palate (CP, mean age 25.5 years); 10 patients with bilateral cleft lip and palate (BCLP, mean age 21.7 years); and 26 patients with unilateral cleft lip and palate (UCLP, mean age 22.9 years). Patients with bimaxillary surgery, simultaneous rhinoplasty, or V-Y plasty of the upper lip were excluded. Soft tissue changes were analyzed by cephalograms taken shortly before surgery and at 6 months postoperatively. Horizontal advancement varied from 4.1 mm in the UCLP group to 5 mm in the BCLP group. The vertical lengthening varied from 3.7 mm in the CP group to 7.2 mm in the BCLP group. In all cleft types, thinning of the subnasal area, superior labial sulcus, and upper lip (anterior nasal spine-subnasale, point A-soft tissue point A, and prosthion-labrale superius) took place. Significant thinning of the upper lip occurred in the UCLP and BCLP patients. Surgical changes of the lower lip and mandibular area were small and insignificant. There were significant differences in soft tissue thicknesses between different types of clefts. The subnasal area and superior labial sulcus were significantly thicker in the CP group than in the BCLP or UCLP groups, both pre- and postoperatively. The upper lip was thickest in the BCLP group preoperatively but thickest in the CP group postoperatively. The upper lip was thinnest in the UCLP group both before and after the operation.     

Nasal airway dimensions of adults with cleft lip and palate: differences among cleft types.

OBJECTIVE: To determine the nasal airway dimensions in adults with repaired cleft lip and palate by rhinomanometry and to analyze the reduction associated with different types of clefts. MODEL: A prospective analysis comparing three types of previously repaired clefts: bilateral cleft lip and palate (BCLP), unilateral cleft lip and palate (UCLP), and isolated cleft palate (CP) at the 5% level of significance. SETTING: Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of S?o Paulo, Bauru, Brazil. PARTICIPANTS: Fifty-three subjects aged 18 to 35 years (17 BCLP, 16 UCLP, 20 CP) and a group of 20 individuals without cleft (N). VARIABLES: Minimum cross-sectional nasal area assessed by posterior (PR) and anterior (AR) rhinomanometry and nasopharyngeal area assessed by modified AR.RESULTS: Mean (+/- 1 SD) nasal areas obtained by PR were: 0.47 +/- 0.16 cm(2) (BCLP), 0.57 +/- 0.19 cm(2) (UCLP), 0.61 +/- 0.13 cm(2) (CP), and 0.60 +/- 0.10 cm(2) (N). The mean value for the BCLP group was significantly smaller than that for the N and CP groups. The remaining values did not differ from one another. The proportion of subjects with subnormal areas obtained by PR was 41%, 19%, and 0% for groups BCLP, UCLP, and CP, respectively. Similar results were obtained by AR. All subjects presented a nasopharyngeal area larger than 0.80 cm(2), denoting absence of obstruction in the nasopharynx. CONCLUSIONS: In adulthood BCLP is the type of cleft associated with a greater reduction of nasal airway, compared with UCLP and CP, suggesting that adults with BCLP are at a greater risk for nasal obstruction.     

The effects of palatoplasty and pre-surgical infant orthopedic treatment on occlusion in unilateral cleft lip and palate patients

PurposeThe aim of this study was to evaluate the effect of pre-surgical infant orthopedic treatment (Hotz plate) and type of palatoplasty on the dental arch relationship and the dental arch morphology of unilateral cleft lip and palate (UCLP) patients.Materials and methodsSeventy-four children with UCLP were divided into three groups. One group had undergone one-stage palatoplasty without Hotz plate (OSP w/o H), the second had undergone one-stage palatoplasty with Hotz plate (OSP w/H), and the third had undergone two-stage palatoplasty with Hotz plate (TSP w/H). We evaluated the dental models which were taken during initial examination at our orthodontic clinic, using the Goslon Yardstick, the 5-year-old index, and dental model analysis.ResultsRegarding both indices, there were no significant differences among the three groups. However, the dental arch width between maxillary deciduous canines in OSP w/H and TSP w/H was significantly greater than that of OSP w/o H. The dental arch width at the maxillary deciduous second molars in TSP w/H was significantly greater than in OSP w/H and OSP w/o H.ConclusionDental arch relationship in UCLP patients was not influenced by the type of palatoplasty and the use of pre-surgical infant orthopedic treatment. Our results suggest that pre-surgical infant orthopedic treatment results in the increase of anterior dental width, whereas two-stage palatoplasty is significantly effective for increasing posterior dental width in UCLP patients.