A cone beam computed tomographic evaluation of the size of the sella turcica in patients with cleft lip and palate

Objective: Changes in the size of the sella turcica are frequently related to pathologies and syndromes. The aim of this was to compare the sella turcica dimensions in patients with unilateral and bilateral cleft lip and palate and non-cleft subjects.

Methods: Cone beam computed tomography (CBCT) images of three groups consisted of 20 patients with unilateral cleft lip and palate; 20 patients with bilateral cleft lip and palate and a control group consisting of 20 non-cleft subjects were the research population in this pilot study. The sella turcica linear dimensions in terms of length, depth and diameter were measured for all subjects. One-way ANOVA test was used to determine any significant differences among the three groups for the measured parameters.

Results: The length, depth and diameter of sella turcica were found to be significantly smaller in the unilateral and bilateral groups compared with the normal age and gender matched group. No significant differences were found in the measured variables between the unilateral and bilateral cleft patients.

Conclusion: CBCT images showed a greater likelihood of abnormal sella turcica dimensions in patients with unilateral and bilateral cleft lip and palate. Therefore, the sella turcica dimensions may have an intrinsic relationship to the cleft condition.     

Cross-sectional study of the length of the nasal bone in cleft lip and palate subjects.

OBJECTIVE: The purpose of this study was to analyze the human nasal bone length in newborns and male adults with cleft lip (CL), cleft palate (CP), and unilateral cleft lip and palate (UCLP) and to compare the results to previous findings in prenatal material. DESIGN: This study was a radiographic profile cephalometric cross-sectional analysis. SUBJECTS AND METHODS: Profile radiographs from 60 newborns with a male-to-female ratio of 1:1 in each group (20 CL, 20 CP, and 20 UCLP) and 60 male adults (20 CL, 20 CP, and 20 UCLP) were randomly selected among radiographs, taken for optimizing the treatment planning. The nasal bone lengths (n-na) were measured with a digital caliper on the profile radiographs. To compare the nasal bone lengths in the different cleft groups, Student's t tests at a significant level at 5% were performed. RESULTS: Nasal bone length was significantly shorter in male adult patients with CL compared with patients with CP. Furthermore, the nasal bone length was significantly shorter in newborns with CL (2 months) compared to newborns with UCLP (2 months). A borderline significance was seen in the comparison of patients with CL and UCLP in male adults. There was no significant difference in the nasal bone length between the patients with CP and UCLP, in either the newborns or the male adults. CONCLUSIONS: Nasal bone length was significantly shorter in subjects with CL compared with subjects in whom the palate was clefted. The results show that the clefted lip in CL is associated with a subjacent skeletal deviation in the upper midface.     

Cleft size at the time of palate repair in complete unilateral cleft lip and palate as an indicator of maxillary growth

Cleft size at the time of palate repair might affect the difficulty of surgical repair and, thus, indirectly postoperative maxillary growth. This retrospective study aimed to determine whether a correlation existed between the cleft size at the time of palate repair and the growth of the maxilla. Maxillary dental casts of 39 infants with non-syndromic complete unilateral cleft lip and palate, taken at the time of palate repair, were used to measure cleft size. Cleft size was defined as the percentage of the total palatal area. The later growth of the maxilla was determined using lateral and postero-anterior cephalometric radiographs taken at 9 years of age. The Pearson correlation analysis was used for statistical analysis. The results showed negative correlations between cleft size and the maxillary length (PMP–ANS, PMP–A) and the maxillary protrusion (S–N–ANS, SNA). These data suggest that in patients with complete unilateral cleft lip and palate there is a significant correlation between the cleft size at the time of palate repair and the maxillary length and protrusion. Patients with a large cleft at the time of palate repair have a shorter and more retrusive maxilla than those with a small cleft by the age of 9 years.     

Craniofacial morphology in children with operated complete unilateral cleft lip and palate

The objective of the study was to compare the craniofacial characteristics of children with operated unilateral complete cleft lip and palate (UCLP) with those of noncleft children. Lateral and posteroanterior cephalometric radiographs of subjects with UCLP and controls who were matched for sex, age, and ethnic origin were analyzed and compared. There were a total of 21 subjects with UCLP (10 boys and 11 girls) from the Orthodontic Department of Selcuk University and 15 controls (7 boys and 8 girls) from the Orthodontic Department of Ankara University. The nasal bone length in the group with cleft did not differ significantly from that in the control group. Subjects with UCLP included in the study appeared to have shorter faces, smaller mandibulae, greater lateral orbital width, and smaller sella turcicae compared with controls. Unilateral cleft lip and palate affects the intracranial morphology as well as dentofacial structures.     

Dental development of Chinese children with cleft lip and palate.

OBJECTIVE: To compare the dental development and rate of tooth development between children with and without cleft lip and palate. Patients: Age- and gender-matched pairs (231 in all) of southern Chinese children ages 3 to 12 years, with and without cleft lip and palate. METHODS: Dental histories and radiographs were studied. From these, dental development was determined. RESULTS: Of 2946 tooth pairs in the children with cleft lip and palate, 252 (8.6%) were found to be asymmetric, significantly (p < .001) more than the 63 of 3179 (2.0%) tooth pairs observed in the children without cleft lip and palate. The teeth with the highest frequency of asymmetry were the maxillary lateral incisors (38.1%). Differences in dental development on the cleft versus noncleft sides of children with unilateral cleft lip and palate were significant for both maxillary and mandibular teeth (p < .001 and p = .039, respectively). The mean delay in tooth formation of the children with cleft lip and palate was 4.4 months relative to the children without cleft lip and palate. The majority of the teeth in the cleft lip and palate group were delayed by one developmental stage. This happened in 40.0% of the maxillary teeth and 30.1% of the mandibular teeth. The delay in tooth formation increased as the number of missing teeth increased in the children with cleft lip and palate, although not significantly. CONCLUSIONS: This group of southern Chinese children with cleft lip and palate demonstrated a higher prevalence of asymmetric and delayed dental development than did their counterparts who did not have cleft lip and palate.     

Evaluation of maxillary central incisors on the noncleft and cleft sides in patients with unilateral cleft lip and palate—Part 1: Relationship between root length and orthodontic tooth movement

Objectives:To measure the root lengths of maxillary central incisors (U1) and evaluate the relationship among U1 root length, tooth movement, and type of treatment appliance in patients with unilateral cleft lip and palate over a long-term follow-up period.Materials and Methods:Occlusal radiographs of 30 patients with unilateral cleft lip and palate, acquired less than 6 months before secondary alveolar bone grafting (SBG, T1) and after edgewise treatment (T2), were measured for U1 root length (R1 and R2, root lengths at T1 and T2, respectively). Frontal and lateral cephalometric radiographs acquired at eruption of U1 (T0), T1, and T2 were evaluated to determine the inclination and position of U1.Results:The average values of R1 and R2 on the cleft side were significantly lower than those on the noncleft side. Frontal cephalometric analysis revealed that the horizontal distance of the root apex from the median vertical line at T0 on the cleft side was significantly smaller than that on the noncleft side and was correlated with short U1 root length on the cleft side. On the other hand, R1 in patients treated with maxillary protraction appliances between T0 and T1 was significantly shorter than that in patients without maxillary protraction appliances. However, none of the changes in cephalometric measurements were correlated with root length.Conclusions:In patients with unilateral cleft lip and palate, the short root length of cleft-adjacent central incisors might be associated with the horizontal position of the root apex. In addition, orthodontic treatment with a maxillary protraction appliance before secondary alveolar bone grafting might be associated with short U1 root length.     

Long-term effects of lip repair on dentofacial morphology in patients with unilateral cleft lip and palate.

OBJECTIVE: Lateral cephalograms from the growth archive of the Sri Lankan Cleft Lip and Palate Project were analyzed in a cohort design to study the long-term effects of lip repair on dentofacial morphology in patients with unilateral cleft lip and palate. METHODS: A total of 71 patients were recruited, including 23 adult patients with nonsyndromic unilateral cleft lip and palate without surgical repair and 48 adult patients with nonsyndromic unilateral cleft lip and palate who had lip repair, but without management of alveolus or anterior vomer. The design utilized exact matching on ethnicity and statistical control for gender and age. RESULTS AND CONCLUSIONS: The data support the hypothesis that lip repair primarily produces a bone-bending effect on the anterior maxillary alveolus (alveolar molding), accompanied by controlled uprighting of maxillary incisors, and secondarily produces a bone-remodeling effect (bone resorption) in the base of the anterior maxillary alveolus. When analyzed by the age at lip repair and the surgeon who performed lip repair, early lip repair produced a greater bone-remodeling effect than did late lip repair, and variation in the surgeon who performed lip repair had an insignificant impact on dentofacial morphology after adjusting for covariates.     

Midfacial morphology in adult unoperated complete unilateral cleft lip and palate patients

OBJECTIVE: To examine lateral cephalometric radiographs of adult unoperated cleft lip and palate patients for the purpose of clarifying whether maxillary deficiencies observed in treated cleft patients result from intrinsic defects or surgical intervention early in life. MATERIALS AND METHODS: This retrospective study examined lateral cephalograms of 30 adult patients with nonsyndromic complete unilateral cleft lip and palate (CUCLP). The lateral cephalograms were traced and evaluated for size and position of the cranial base, maxilla, maxillary dentition, mandible, and mandibular dentition as well as for vertical relationships. Comparisons with 30 adult noncleft individuals were made. RESULTS: In unoperated adult cleft lip and palate patients, the cranial base angle was increased with the anterior cranial base reduced in length. The maxilla was found to be normal in size and somewhat prognathic in position. Both the maxillary and mandibular incisors were relatively upright. The mandible was smaller in size and posteriorly positioned. CONCLUSIONS: The potential for normal growth of the maxilla exists in patients with CUCLP. It is likely that disturbances of maxillary growth in surgically operated cleft patients are related primarily to the surgical intervention.     

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.     

唇裂修复术对唇腭裂患者上颌骨生长发育的影响

目的:探讨唇裂修复术在单侧完全性唇腭裂患者上颌骨生长受限中的作用。方法:52例唇裂修复术后的单侧完全性唇腭裂恒牙列期患者,依是否已行腭裂修复分成两个实验组,通过头颅侧位头影测量片研究两组患者上颌骨生长变化规律,并与正常对照组比较。结果:唇腭裂均修复组与仅唇裂修复组具有基本相似的上颌骨生长抑制。结论:唇裂修复术是影响单侧完全性唇腭裂患者上颌骨生长受抑的重要因素。     

Long-term effects of palate repair on craniofacial morphology in patients with unilateral cleft lip and palate.

OBJECTIVE: To identify the long-term effects of palate repair on craniofacial growth in patients with unilateral cleft lip and palate (UCLP). DESIGN: Retrospective cross-sectional study. SETTING: Sri Lankan Cleft Lip and Palate Project. SUBJECTS: Forty-eight adults with nonsyndromic unilateral cleft lip and palate, 29 men and 19 women, had lip repair only (LRO group). Fifty-eight adults with nonsyndromic unilateral cleft lip and palate, 35 men and 23 women, had lip and palate repairs by the age of 9 (LPR group). MAIN OUTCOME MEASURES: Clinical notes were used to record surgical treatment histories. Cephalometry was used to determine craniofacial morphology. RESULTS: In the lip and palate repair group, the depth of the bony pharynx (Ba-PMP), the maxillary length at the alveolar level (PMP-A), the effective length of the maxilla (Ar-IZ, Ar-ANS, Ar-A), the maxillary protrusion (S-N-ANS, SNA), the anteroposterior jaw relation (ANS-N-Pog, ANB), and the overjet were smaller than in the lip repair only group. There were no significant differences in the maxillary length at the basal level (PMP-IZ, PMP-ANS) and the anterior and posterior maxillary heights (N-ANS and R-PMP, respectively) in the two groups. CONCLUSION: Palate repair inhibits the forward displacement of the basal maxilla and anteroposterior development of the maxillary dentoalveolus in patients with unilateral cleft lip and palate. Palate repair has no detrimental effects on the downward displacement of the basal maxilla or on palatal remodeling in patients with unilateral cleft lip and palate.     

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.     

Effects of lip repair on maxillary growth and facial soft tissue development in patients with a complete unilateral cleft of lip, alveolus and palate.

PURPOSE: To examine the relationship between lip repair and inhibition of maxillary growth, and to investigate the characteristics of upper lip in patients with complete unilateral clefts of lip, alveolus and palate. MATERIAL AND METHODS: Lateral cephalometric radiographs and photographs (anterior-posterior and profile) were taken for 3 groups of patients: (1) 35 complete unilateral cleft lip, alveolus and palate cases in whom only a labioplasty was performed as infants; (2) 47 cases who had both lip and palate repaired; and (3) 37 non-cleft peers as controls. RESULTS: There was maxillary retrusion in groups (1) and (2). Surface area and height of the upper lip was reduced in both these groups when compared with the normal controls. CONCLUSION: Lip repair is a most important factor in the restraint of maxillary growth in patients with complete unilateral clefts of lip, alveolus and palate. And height and projection of the upper lip are reduced following lip repair.     

Impact of rapid maxillary expansion in unilateral cleft lip and palate patients after secondary alveolar bone grafting: review and case report

The purpose of this article was to analyze the effects and short-term stability of rapid maxillary expansion performed after secondary alveolar bone grafting in unilateral cleft lip and palate (UCLP) patients. Two UCLP patients with severe maxillary constriction who had previous bone grafting were involved in this study. A hyrax rapid expansion appliance was placed on 4 abutment teeth and activated twice daily. An opening of the midpalatal suture was found on the posttreatment occlusal radiographs, which was clinically confirmed by the diastema. Posteroanterior cephalometric tracing analysis demonstrated significant increases in maxillary and dental arch width. No obvious radiographic alteration was observed in the grafted areas.     

Unilateral advancement of the maxillary minor segment by distraction osteogenesis in patients with repaired unilateral cleft lip and palate: report of two cases.

OBJECTIVE: Collapse of the maxillary minor segment with lateral crossbite is a common feature in patients with repaired unilateral cleft lip/palate because of maxillary alveolar bony defect and palatal scar tissue. Distraction osteogenesis (DOG) is an effective technique of lengthening and augmentation for bone and gingiva. This case report describes the effects of unilateral advancement of the maxillary minor segment by DOG in two patients with the repaired unilateral cleft lip/palate.     

Eruption of incisor teeth in cleft lip and palate

Longitudinal frontal and lateral cephalometric radiographs were used to study the path of eruption of the permanent central incisors approximating the cleft areas in 15 subjects with unilateral and 7 subjects with bilateral complete clefts of the lip and palate, aged between 3 years 8 months and 9 years. Tracings from the longitudinal transparent templates of the Bolton Standards subjects were used as controls for comparative purposes. The findings indicate that the pattern of eruption of the maxillary central incisor follows the pattern of alveolar development in the cleft subjects. The position of the premaxilla subsequent to cleft repair influences the eruption pattern of the maxillary central incisors approximating the cleft areas. The central incisors erupt down and back, and become more retroclined and retropositioned within the nasomaxillary complex, with increment in age. The crowns of the central incisors approximating the cleft in unilateral cleft lip and palate subjects progressively tipped more towards the cleft with age.     

Hard palate repair timing and facial morphology in unilateral cleft lip and palate: Before versus after pubertal peak velocity age.

OBJECTIVE: To investigate whether timing of hard palate repair, before versus after pubertal peak velocity age, had a significant effect on facial growth in patients with unilateral cleft lip and palate. DESIGN: Retrospective cross-sectional study. Setting: Sri Lankan Cleft Lip and Palate Project. PATIENTS: A total of 125 adult patients with nonsyndromic unilateral cleft lip and palate were recruited and their last cephalometric radiographs were used. MAIN OUTCOME MEASURES: Clinical notes were used to record surgical treatment histories. Cephalometry was used to determine facial morphology. RESULTS: The patients who had hard palate repair after pubertal peak velocity age had a deeper bony pharynx (Ba-PMP), a longer alveolar maxilla (PMP-A), a longer effective length of the maxilla (Ar-ANS, Ar-A), and as a result had a more favorable anteroposterior jaw relation (ANS-N-Pog, ANB, NAPog) and larger overjet, compared with those who had hard palate repair before pubertal peak velocity age. CONCLUSION: Timing of hard palate repair significantly affects the growth of the maxilla in patients with unilateral cleft lip and palate. Hard palate repair after (versus before) pubertal peak velocity age has a smaller adverse effect on the forward growth of the maxilla. This timing affects the forward displacement of the basal maxilla and the anteroposterior development of the maxillary dentoalveolus.     

Early postnatal development of the mandible in children with isolated cleft palate and children with nonsyndromic Robin sequence.

OBJECTIVE: Analysis of early postnatal mandibular size and growth velocity in children with untreated isolated cleft palate (ICP), nonsyndromic Robin sequence (RS), and a control group of children with unilateral incomplete cleft lip (UICL). MATERIAL: 114 children (66 isolated cleft palate, 7 Robin sequence, 41 unilateral incomplete cleft lip) drawn from a group representing all Danish cleft children born from 1976 through 1981. All children were examined at both 2 and 22 months of age. METHODS: Cephalometric x-rays and maxillary plaster casts. Mandibular length and height were measured and mandibular growth velocity (mm/year) was calculated. Cleft width was measured on the casts at 2 months of age. RESULTS: Mean mandibular length and posterior height were significantly smaller in isolated cleft palate and Robin sequence, compared with unilateral incomplete cleft lip. Mandibular length in Robin sequence was also significantly shorter, compared with isolated cleft palate. No significant difference was found between mean mandibular growth velocities in the three groups. No significant correlation was found between mandibular length and cleft width in either isolated cleft palate or Robin sequence at 2 months of age. CONCLUSION: The children with isolated cleft palate and Robin sequence had small mandibles shortly after birth, but with a relatively normal growth potential. No true mandibular catch-up growth was found up to 22 months of age in either group. No significant correlation was found between mandibular size and cleft width in either group at 2 months of age. However, there was a significant trend toward the shorter the mandible, the more severe the sagittal extension of the cleft.     

Maxillary distraction in cleft lip palate patients: a review of six cases.

Cleft lip and palate patients can present with a maxillary retrusion with tendency to Class III malocclusion after cleft repair. Maxillary distraction osteogenesis is a technique that provides simultaneous skeletal advancement and expansion of the soft tissues. Six nonsyndromic cleft lip and palate patients, ages 12 to 16 years (mean, 13.8 years), underwent maxillary distraction; four had a unilateral and two a bilateral cleft lip and palate. After an incomplete LeFort I osteotomy; a latency period of 3 days was respected. On Postoperative Day 4, distraction was initiated through anterior traction on a Delaire facial mask using distraction forces of 900 gm. Photographs and lateral cephalometric radiographs were obtained preoperatively and 4 months after distraction. A cephalometric analysis was performed to compare the sagittal dentocraniofacial morphology before and after distraction. The aesthetic improvement obtained by maxillary distraction osteogenesis during the permanent dentition to correct maxillary retrusion in our cleft lip and palate patients was impressive. Skeletal advancement varying from 1 to 3.5 mm (mean, 1.7 mm) was found. However, significant dentoalveolar compensations occurred in three patients. This was due to the dental anchorage of the distraction device and can be avoided only by the use of skeletal fixation.     

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先天性唇腭裂是新生儿常见的先天畸形,大多数患儿在婴幼儿时期接受了手术治疗,但很多患者随发育表现出上颌骨发育不良。这种影响是由于疾病本身造成的,还是与手术相关,目前仍在研究中。本文就唇裂手术对上颌骨发育的影响做一综述。