Comparisons of Facial Growth in Patients With Unilateral Cleft Lip and Palate Treated by Different Regimens for Two-Stage Palatal Repair

Abstract

The aim of this study was to compare facial development, particularly growth of the maxilla, of two groups of patients with unilateral cleft lip and palate in whom palatal surgery had been done slightly differently, particularly the timing of the procedures. Two-stage palatal repair had been used at 8 (velar closure) and 102 months (hard palate surgery) at one cleft centre and at 20 and 62 months at another centre. Lateral roentgencephalograms were used to analyse the first sample of 20 patients, who were followed longitudinally from 7-16 years of age. The other group comprised 17 subjects in the same age range, who were investigated cross-sectionally, also by cephalometry. Generally, the outcome of the two surgical regimens was similar and equally satisfactory, with no evident difference in facial or maxillary morphology between the two samples. From the midfacial growth point of view, it might be questioned whether it is necessary to delay closure of the cleft in the hard palate until the mixed dentition stage as was done at the first cleft centre.

One- or Two-Stage Palate Closure in Patients with Unilateral Cleft Lip and Palate: Comparing Cephalometric and Occlusal Outcomes

“…Noverraz et al (1993) reached the same conclusion after analyzing the dental casts of four different patient groups whose hard palates had been closed at various times. Likewise, Friede et al (1999) could not state an evident difference in midfacial growth in two groups of patients who underwent delayed hard palate surgery at two different time points. Gaggl et al (2003) compared two groups of adult patients and reported the development of sagittal and transversal maxillary dimensions to be even better in the group who had undergone the single-stage procedure.…”

Craniofacial morphological outcome following treatment with three different surgical protocols for complete unilateral cleft lip and palate: a premilinary study

“…Many authors 1,4,5,7,12 noted reduction of maxillo-mandibular discrepancy (ANB) in cleft patients. The present results indicated a significantly decreased ANB angle in group I patients (p < 001) compared with groups II and III.…”

“…[1][2][3][4][5][6]11 Different management protocols have different impact on the development of craniofacial morphology. 4,7,8,13,15,[17][18][19]24,[27][28][29] This study has compared the craniofacial morphology of children with complete unilateral cleft lip and palate treated with three different surgical protocols, the only difference which is in the technique employed to perform hard palate closure.…”

“…Several papers have investigated craniofacial morphology in children with cleft disorders, 2,14,21,25 but there are only a handful of cross-center trials indicating the impact of different surgical protocols on craniofacial growth and development. 1,[3][4][5][6]11,15,18,22,24,27 A large number of different surgical treatment techniques and varied assessment criteria impede the formulation of an optimum treatment method.…”

The effect of 1-stage versus 2-stage palate repair on facial growth in patients with cleft lip and palate: a review

“…FRIEDE et al 3 questioned whether it is necessary to delay closure until 9 years of age rather than 5 years, because similar and satisfactory maxillary growth was found in two samples in which patients underwent surgery at the two different ages. They speculated that by starting closure of the soft palate, the size of the remaining hard palate narrows spontaneously 17 , facilitating a smaller, less invasive, later hard palate repair.…”