Maxillary arch dimensions in cleft infants in Northern Finland

Abstract

Objective. The aim of this study was to examine the maxillary arch dimensions in cleft lip and/or palate infants in Northern Finland before surgery. Materials and methods. The subjects consisted of 70 Finnish cleft patients born between 1997–2004 in Northern Ostrobothnia Hospital District in Finland. The study casts were obtained before surgery at the mean age of 5.6 months (SD = 2.2). There were 42 children with cleft palate (CP) (26 girls/16 boys), 13 with unilateral cleft lip and palate (UCLP) (eight girls/five boys), eight children with cleft lip (CL)(two girls/six boys) and seven with bilateral cleft lip and palate (BCLP) (two girls/five boys). Conventionally-used landmarks were marked on study casts and cleft width, arch circumference, anterior and posterior arch width and arch length were measured with a digital sliding calliper. The statistical method was ANOVA. Results. The prevalence of CP in this study, 60% of all clefts, is higher than the average standards. There were statistically significant differences in cleft width, posterior and anterior arch width, arch length and arch circumference, when different cleft groups were compared. When differences between girls and boys were compared, boys had larger cleft size and arch dimensions generally, but the results were not statistically significant. Conclusions. The results show the large variation in the severity of cleft lip and/or palate deformity at birth and in maxillary arch dimensions between different cleft types. It also demonstrates the effect of phenotypic variability within the groups of cleft lip and/or palate.     

Palate morphology after unilateral and bilateral cleft lip and palate closure

The aim of the present study was to compare the morphology of the hard palate of patients with uni- and bilateral cleft lip and palate after palatoplasty using vomer and palatal pedicled flaps with the palatal morphology of non-cleft individuals. Eighty patients were enrolled into this retrospective study: 40 patients with cleft lip and palate (30 unilateral, 10 bilateral) and 40 non-cleft patients with class I occlusion, who served as controls. Analysis of the development of the maxillary arch and evaluation of palatal morphology were accomplished from reformatted CT scans from plaster casts of the maxilla at the age of 4, 10 and 15 years (cleft patients) and 10 years (controls). Width and symmetry of the maxillary arch and morphology of the hard palate were assessed in the canine and molar region and compared both among the cleft groups and the controls. Maxillary arch width as assessed from plaster casts did not differ significantly between uni- and bilateral cleft patients and was not significantly different from controls at the age of 10. Deviation from symmetry was present in both types of cleft and significant in unilateral clefts when compared to bilateral clefts and non-cleft patients. Palatal morphology did not differ significantly between uni- and bilateral clefts until the age of 15, but was significantly different from control patients in the molar area at the age of 10 presumably due to the medial shift of soft tissue flaps used for palatoplasty. It is concluded that palatoplasty significantly alters hard palate morphology particularly in the posterior area. The relevance of this alteration for speech and articulation remains to be explored.     

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。     

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.     

A comparison of growth impairment and orthodontic results in adult patients with clefts of palate and unilateral clefts of lip, palate and alveolus

OBJECTIVE: To evaluate and compare the long-term aesthetic and functional results of surgical and orthodontic treatment in patients with cleft palate and unilateral cleft lip, palate, and alveolus. DESIGN: 30 patients with unilateral cleft lip, palate, and alveolus and 30 patients with isolated cleft palate, mean age of 18.9 years, were evaluated by cephalometric and model analysis a mean of 1.5 years after orthodontic treatment. In each group the surgical treatment has been similar. RESULTS: Model analysis: The sum of every mesiodistal tooth diameter in the maxilla and in the mandible was recorded according to the Bolton analysis. Twenty patients with unilateral cleft lip, palate and alveolus had relatively large upper dental arches and nine had relatively large lower dental arches. Twenty-two patients with cleft palates had large upper dental arches and seven had large mandibular arches. Eleven patients with unilateral cleft lip, palate, and alveolus and 18 patients with cleft palate had a negative space supply (the sum of the mesiodistal tooth diameters compared with the sagittal length of the alveolar ridge) in the region of the lateral teeth. All patients had persistent transverse space deficits that were increased on the side of the cleft in patients with cleft lip, palate, and alveolus. These unilateral transversal space deficits were recorded in 22 patients with unilateral cleft lip, palate, and alveolus and in 8 patients with isolated cleft palate. Sagittal measurements were reduced in 26 patients with unilateral cleft lip, palate, and alveolus and in 23 patients with cleft palate alone. The alveolar midline of the maxilla and the mandible were displaced in 25 patients with unilateral cleft lip, palate, and alveolus and in 19 patients with isolated cleft palate. Lateral cephalometric analysis: The lateral cephalograms taken at the same time as the models showed a mean SNA of 76.8 degrees and a NL-NSL angle of 8.7 degrees, indications of a tendency towards maxillary retrognathia in patients with unilateral cleft lip, palate, and alveolus. Patients with cleft palate had a mean SNA of 79.6 degrees and NL-NSL angle of 8.1 degrees. The anterior facial vertical index was within normal limits in patients with cleft lip, palate, and alveolus (44% vs 56%). An anterior facial height index of 42% compared with 58% in patients with isolated cleft palate indicated a slight reduction in midface height with an increase in the lower face as a consequence. CONCLUSION: Orthodontic and surgical treatment can result in satisfactory results on model analysis. However, there is specific growth impairment of the maxilla 1.5 years after termination of orthodontic treatment and this influences the final cephalometric analysis, particularly in patients with cleft lip, palate, and alveolus.     

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.     

Infant orthopedics has no effect on maxillary arch dimensions in the deciduous dentition of children with complete unilateral cleft lip and palate (Dutchcleft).

OBJECTIVE: Evaluation of the effect of infant orthopedics on maxillary arch dimensions in the deciduous dentition in patients with unilateral cleft lip and palate. DESIGN: Prospective two-arm randomized controlled clinical trial with three participating cleft palate centers. SETTING: Cleft palate centers of the Radboud University Nijmegen Medical Center, Academic Center of Dentistry Amsterdam, and University Medical Center Rotterdam, the Netherlands. PATIENTS: Children with complete unilateral cleft lip and palate (n = 54) were included. INTERVENTIONS: Patients were randomly divided into two groups. Half of the patients (IO+) had a presurgical orthopedic plate until surgical closure of the soft palate at the age of 52 weeks; the other half (IO-) did not undergo presurgical orthopedics. MEAN OUTCOME MEASURES: Maxillary arch dimensions were assessed on dental casts at 4 and 6 years of age with measurements for arch width, arch depth, arch length, arch form, and the vertical position of the lesser segment. Contact and collapse were assessed also. RESULTS: There were no clinically significant differences found between IO+ and IO- for any of the variables. CONCLUSIONS: Infant orthopedics had no observable effect on the maxillary arch dimensions or on the contact and collapse scores in the deciduous dentition at the ages of 4 and 6 years. Considering the Dutchcleft results to date, there is no need to perform infant orthopedics for unilateral cleft lip and palate patients.     

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.     

Maxillary and sella turcica morphology in newborns with cleft lip and palate.

OBJECTIVE: The first aim was to examine maxillary developmental fields by analyzing bone size parameters within the maxillary bone complex in newborns with unilateral cleft lip (UCL) and unilateral cleft lip and palate (UCLP). The second aim was to evaluate sella turcica morphology in unilateral cleft lip and unilateral cleft lip and palate. SUBJECTS AND METHODS: Axial and profile radiographs from 40 newborns (boy-girl, 1:1) in each group (20 unilateral cleft lip and 20 unilateral cleft lip and palate) were randomly selected among radiographs taken for optimizing treatment planning. Analysis of maxillary bone size was performed on axial radiographs and size parameters were measured. Furthermore, analysis of sella turcica morphology was performed on profile radiographs. The results were divided into groups with normal morphology and severe deviations in the morphology. RESULTS: The maxillary areas were significantly shorter and broader in unilateral cleft lip and palate than in unilateral cleft lip. A profound asymmetry in the maxillary areas was seen in unilateral cleft lip and palate, but not in unilateral cleft lip. In both cleft types, approximately half of the individuals had deviations in sella turcica morphology. The most severe deviations occurred in newborns with unilateral cleft lip and palate. CONCLUSIONS: In newborns with unilateral cleft lip and palate, the maxillary areas are significantly shorter, broader, and more asymmetric than in newborns with unilateral cleft lip. The present study showed that bone structures are a suitable parameter for characterizing the craniofacial developmental fields. Additionally, a high incidence of deviations in sella turcica morphology might indicate that this area is affected in individuals with clefts.     

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.     

Dental arch dimensions in patients with unilateral cleft lip and palate

In this investigation, dental arch dimensions during different ages were studied in 72 children with unilateral cleft of the lip, alveolar process, and palate and were compared with those of normal children. All the children with clefts were treated surgically by surgeons of the Lancaster Cleft Palate Clinic. The dental arch dimensions were studied with the use of dental casts during the time of full deciduous dentition (3 to 4 years of age), mixed dentition (8 to 9 years of age), and permanent dentition (12 years of age). The major findings were: (1) all maxillary interdental widths and lengths were significantly smaller than the normal dimensions at all ages, except for intermolar width at age 12 years; and (2) the mandibular arch dimensions seemed to be related to changes in the maxillary arch; however, the influence of surgical procedures in the maxillary arch is not reflected severely in mandibular arch dental position.     

Cleft lip and palate in Denmark, 1976-1981: epidemiology, variability, and early somatic development

The present investigation describes the incidence and variability of the primary cleft condition in all Danish infants born with cleft lip, cleft palate, or both, from 1976 to 1981 and analyzes general somatic growth from birth to age 22 months. Because of excellent sampling conditions in Denmark, the study material is nearly complete. Six hundred and seventy-eight infants with facial clefts were born during the period, corresponding to 1.89 per 1,000 of all newborns. Six hundred and two patients were examined--most of them twice: at 2 months and at 22 months. Material uptake included plaster casts of the upper jaw, cephalometric films in three projections, anthropometric registrations, and information from hospital charts. A detailed grading of the clefts according to severity was carried out. Sex distribution was 61% males and 39% females, of whom 34% had isolated cleft lip, 39% combined cleft lip and palate, and 27% an isolated cleft palate. Left-sided clefts were most frequent. In the combined cleft lip and palate group, 90% exhibited subtotal or total clefts, whereas the clefts were less severe in the isolated cleft lip and isolated cleft palate patients. Birth weight and length showed values close to the average for Danish newborns, but a lag was seen in infants in whom severe palatal cleft was included. The extended method of classification was suggested to select subgroups for special care.     

Morphologic and management characteristics of individuals with unilateral cleft lip and palate who required maxillary advancement.

OBJECTIVE: To delineate factors that may contribute to maxillary hypoplasia requiring maxillary advancement surgery in individuals with nonsyndromic unilateral cleft lip and palate (UCLP). METHODS: This retrospective, longitudinal study used lateral cephalometric radiographs and chart reviews of 16 nonsyndromic UCLP individuals who underwent Le Fort I maxillary advancement and 16 controls matched for cleft type, age, and gender. Cephalometric measurements were made at three time points (T1, T2, and T3): mean ages of 10.7, 13.3, and 15.8 years for the Le Fort group and 10.11, 12.9, and 15.7 years, respectively, for the control group. Information regarding team care, timing and number of surgical procedures, and number of congenitally missing teeth were determined from clinical records. RESULTS: The Le Fort group had significant maxillary hypoplasia at all time points compared to the UCLP controls, indicated by midface length measurements, ANB and Wit's analysis (p < .001). The Le Fort group had twice the number of palatal surgical procedures and number of missing teeth in the maxillary arch as compared with the cleft controls. Most of the control group had consistent team care, while most of the surgical group did not. CONCLUSIONS: Maxillary hypoplasia that will require a Le Fort I advancement can be determined as early as age 10. Multiple missing maxillary teeth, secondary palate procedures including pharyngeal flaps, and inconsistent team care with delayed orthodontic intervention are contributing factors to maxillary underdevelopment.     

Comparative study between children with and without cleft lip and cleft palate, part 2: electromyographic analysis.

OBJECTIVE: This study was conducted to compare electromyographic (EMG) activity of superior orbicularis oris muscle between children with repaired cleft lip and cleft palate and children without clefts. METHODS: This study included 28 children with mixed dentition. They were divided into two groups. The study group included 14 children with repaired unilateral cleft lip and cleft palate, ranging in age from 6 to 12 years, who presented clinically with a short upper lip, abnormal lip seal, and inhibition of sagittal development of the midface as assessed radiographically. The control group included 14 children without clefts ranging in age from 8 to 11 years. All had normal lip seal, nasal breathing, and a clinically normal body posture. DESIGN: Bipolar surface electrodes were used for EMG recordings of resting level activity and during swallowing of saliva, speech, and chewing and swallowing of an apple. RESULTS AND CONCLUSIONS: A significantly higher level of activity at rest and during swallowing of saliva was observed in the cleft lip and cleft palate group. Similar activity during speech and chewing and swallowing of an apple was observed in both groups. The higher level of activity at rest and during swallowing of saliva in children with cleft lip and cleft palate seems to suggest that upon higher functional demands their activity increases less than in children without clefts. From a clinical point of view, if increased EMG activity at rest and during swallowing of saliva reflects increased force on the maxilla, then our findings may corroborate Bardach's findings (1990) that surgical treatment of cleft lip has an iatrogenic effect on facial growth, although the lack of significant correlation between the cephalometric data and EMG findings in the present study.     

Asymmetry of the maxilla in children with complete unilateral cleft lip and palate

Craniofacial asymmetry was analyzed in 31 children with unilateral cleft lip and palate (UCLP) and compared to a group of 24 children with incomplete clefts of the lip (CL). Symmetry was evaluated from 32 variables on posteroanterior cephalometric radiographs. Two types of asymmetry were identified: In the first, there was a positional deviation and a change of arch shape of the maxillary segment on the cleft side. The basal maxillary width was similar in the two groups. At the dentoalveolar level a decrease in width was localized to the cleft side in the UCLP group. Maxillary height of the cleft segment was reduced. The second type was related to the anterior part of the maxilla and the nasal septum. The inferior border of the bony part of the nasal septum deviated towards the cleft side. The anterior nasal spine and the midpoint between the upper central incisors deviated toward the noncleft side, but to a different degree indicating a vertical tilting of the premaxillary region.     

Relapse tendency in maxillary arch width in unilateral cleft lip and palate patients with different maxillary arch forms.

OBJECTIVE: The aim of this study was to investigate the relapse tendency in the maxillary dental arch widths in unilateral cleft lip and palate patients with different types of maxillary arch form. SUBJECTS: Thirty-two unilateral cleft lip and palate patients treated by one-stage surgical palatal closure were included. The subjects were divided into three groups according to the types of the maxillary arch forms: group A, symmetrical arch form; group B, collapse of minor segment; group C, collapse of both segments. METHODS: Using dental casts obtained at three different times, relapse in the intercanine, interpremolar, and intermolar widths in each group was assessed and differences between groups were investigated. Results: Patients in group A showed stable results in all measurements. Patients in group B showed posttreatment relapse in the intercanine width only, whereas patients in group C demonstrated significant posttreatment relapses in the interpremolar and intermolar widths. Comparison between groups showed more significant relapse in the interpremolar and intermolar widths of group C than in those of group B. CONCLUSION: The types of the maxillary arch forms in unilateral cleft lip and palate patients might play a stronger role in the stability of the maxillary dental arch widths after orthodontic treatment in patients with collapse of both segments and a severe degree of maxillary narrowness.     

Sizes of dental arches and interdental space in 3-year-old children with and without cleft lip/palate

The development of the dental arches in children with oral clefts differs from that in a normal population, due to the type and extension of the cleft, surgical procedure and timing, and decreased growth potential. The size of the maxillary and mandibular dental arches and the amount of interdental space in 3-year-old, cleft-affected and non-cleft children was investigated. Fifty non-cleft (NONC) and 104 cleft-affected subjects including different cleft groups were compared. On average, cleft lip was corrected at the age of 0.6 years and cleft palate at 1.8 years of age. The mean of all width and depth dimensions in the cleft lip group were close to the NONC controls, whereas the dimensions of the cleft palate group were 8-9 per cent smaller in the maxilla and 5-7 per cent smaller in the mandible than were those in the NONC group. In the unilateral complete cleft group, the maxillary dimensions were 11-19 per cent smaller, but in the mandible only 0-4 per cent smaller than in the NONC group. In the bilateral complete cleft group, the maxillary arch was only 6 per cent shorter but 30 per cent narrower at the canines than in the NONC group. In the mandible the corresponding differences were 2 per cent and 6 per cent. Forty per cent of the cleft palate subjects had a crowded maxillary arch compared with 6 per cent of the NONC controls.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prevalence of enamel hypoplasia in deciduous canines of patients with complete cleft lip and palate.

OBJECTIVE: To evaluate the prevalence and type of enamel hypoplasia in deciduous canines of patients with complete unilateral and bilateral cleft lip and palate, as well as its distribution according to gender, dental arch, and side of cleft. DESIGN: Cross sectional. SETTING: Hospital for Rehabilitation of Craniofacial Anomalies, Bauru, S?o Paulo, Brazil. MATERIAL AND METHODS: Three-hundred twelve Caucasian children (193 boys, 119 girls), aged 3 to 10 years, presenting complete unilateral and bilateral cleft lip and palate were included in this study. A single examiner carried out clinical examination under natural light with a dental probe and dental mirror and, after drying of the tooth, by means of a simplified hypoplasia index. RESULTS: A prevalence of 43.8% was observed for unilateral and 39% for bilateral clefts. Both groups revealed similar distributions regarding the maxillary and mandibular dental arches and gender. Similar distribution was also observed on the cleft and noncleft sides for the unilateral cleft group. The most frequent type and severity was obvious hypoplasia, followed by minimal hypoplasia, both roughly round. CONCLUSION: The results suggest that the cleft does not influence the occurrence of hypoplasia in deciduous canines.     

Asymmetry of left versus right unilateral cleft impairments: an experimental study of face perception.

OBJECTIVE: Previous psychosocial studies of adults born with cleft lip and palate have provided circumstantial evidence that surgically repaired right-sided unilateral clefts may be more disfiguring than left-sided clefts. The present study asked if such asymmetries are physiognomic asymmetries or arise "in the eye of the beholder," representing perceptual processes in face recognition. DESIGN: Color slides of 160 children (6 years of age) and young teenagers (16 years of age) were rated by subjects for perceived disfigurement. Sixty of the subjects had unilateral complete cleft lip and palate (30 had a right-sided cleft and 30 had a left-sided cleft), 60 had unilateral cleft lip/alveolus (30 right-sided and 30 left-sided clefts), 32 children had bilateral cleft lip and palate, and 8 children had cleft palate only. Faces were shown in normal and in mirror-reversed versions; the order in which faces were shown was randomized, as were other stimulus factors such as cleft type, age, and gender. SETTING: The study was conducted as a classroom-type experiment at the Vision Laboratory, Department of Psychology, Oslo, Norway. PARTICIPANTS: Thirty-seven students of psychology at the University of Oslo, who were ignorant of the purpose of the study, acted as subjects. MAIN OUTCOME MEASURE: Subjects rated perceived disfigurement using a visual analog scale. RESULTS: Modest but highly consistent hemifacial asymmetries in judged disfigurement were found, with left-sided unilateral clefts rated as less disfiguring than right-sided unilateral clefts. Unilateral clefts were judged as being less disfiguring than the bilateral clefts, and cleft lip/alveolus was judged as being less disfiguring than cleft lip and palate. The patterns of facial judgments were almost identical in the normal and reversed-slides conditions. CONCLUSIONS: Asymmetries between left- and right-sided clefts reside in physiognomic factors rather than in hemispheric asymmetries controlling the perceptual process of face judgment.     

Speech evaluation and dental arch shape following pushback palatoplasty in cleft palate patients: Supraperiosteal flap technique versus mucoperiosteal flap technique.

BACKGROUND: The aim of this study was to evaluate and compare the maxillary dental arch shape and speech of cleft palate patients following pushback palatoplasty using either the supraperiosteal flap technique or the mucoperiosteal flap technique. PATIENTS: Sixty-two patients (29, cleft palate only; 33, unilateral cleft lip, alveolus and palate) operated on by the supraperiosteal technique and 47 patients (23, cleft palate only; 24 unilateral cleft lip, alveolus and palate) by the mucoperiosteal technique were reviewed in this study. Study design: Dental arch shape and speech proficiency at preschool and school age were evaluated in all patients. RESULTS: Dental arch shapes were classified as U type (good dental arch shape) and V type (narrow dental arch shape). In cleft palate only patients, U type was observed in 90% of the supraperiosteal group and 83% of the mucoperiosteal group. In unilateral cleft lip, alveolus and palate patients, U type was observed in 85% of the supraperiosteal group, while only in 33% of the mucoperiosteal group. In cleft palate only patients, normal speech at school age was observed 100% of the supraperiosteal group and 83% of the mucoperiosteal group. In unilateral cleft lip, alveolus and palate patients, normal speech at school age was observed in 97% of the supraperiosteal group and 75% of the mucoperiosteal group. Misarticulation was frequently found in patients with the V type of dental arch shape. CONCLUSION: It is suggested that pushback palatoplasty using the supraperiosteal technique is more advantageous for speech development compared with the mucoperiosteal technique.