Dental Arch Relationship Outcomes Following 2-Stage Palatoplasty for Japanese Patients With Complete Unilateral Cleft Lip and Palate: A 3-Center Study

Abstract

Objective: To compare dental arch relationship outcomes following 3 different 2-stage palatal repair protocols. Design: Retrospective, cross sectional. Setting: Three cleft palate centers (A, B, C) in Japan. Patients: Ninety (A: 39, B: 26, C: 25) consecutively treated Japanese patients with complete unilateral cleft lip and palate. Interventions: In A, the soft palate and the posterior half of the hard palate were repaired at a mean age of 1 year 7 months. In B, the soft palate and hard palate were closed separately at a mean age of 1 year 6 months and 5 years 8 months, respectively. In C, the soft palate and hard palate were closed at a mean age of 1 year and 1 year 5 months, respectively. Main Outcome Measures: Dental arch relationships were assessed using the 5-Year-Olds’ (5-Y) index by 5 raters and the Huddart/Bodenham (HB) index by 2 raters. Results: Intra- and inter-rater reliabilities showed substantial or almost perfect agreement for the 5-Y and HB ratings. No significant differences in mean values and distributions of 5-Y scores were found among the 3 centers. The mean HB index scores of molars on the minor segment were significantly smaller in C than those in A and B ( P < .05). Conclusions: There were no significant differences in dental arch relationships at 5 years among the times and techniques of hard palate closure. However, further analysis of the possible influence of infant cleft size as a covariable on a larger sample size is needed.

Maxillary Development and Dental Arch Relationships Following Early Two-Stage Palatoplasty: A Comparative Study

“…A multicenter study reported the 5-year-old-index score of 3.08 obtained from the ETS protocol conducted at a center different from ours. 9 Despite the fact that younger patients tend to show better occlusal relationships, 51 the other center appeared to present better occlusal relationships. A major difference between the two centers is the number of surgeons who were involved in the protocol; a single surgeon in the other center versus 4 surgeons in the present study.…”

“…However, a previous study on the ETS protocol did not show such results. 9 Further investigations are necessary.…”

“…Actually, a study from another center reported favorable speech outcomes with this protocol when patients were 4 years of age. 9 They showed that the ETS protocol resulted in both velopharyngeal function and the occurrence of articulation errors equivalent to those obtained after conventional 1-stage pushback palatoplasty, which is an established technique suitable for speech outcome rather than palatal development. 33,34 Another advantage of this protocol, based on our experience, is that it does not require a palatal appliance to obturate the residual cleft during the interval period.…”

“…6 As the interval between the soft palate plasty and the hard palate closure is short, it is concerning whether this protocol actually provides favorable palatal development. Accumulating evidence has shown that this protocol is suitable for maxillary growth, [7][8][9] as well as speech development. 10 However, controversy persists.…”

Real-Time Image-Guided Navigation in the Management of Alveolar Cleft Repair

“…Alveolar cleft is a bony defect that involves the maxillary arch. As a key step in the sequential treatment of cleft lip and palate, alveolar cleft repair aims at reconstructing the continuity of dental arch and overall alveolar process, providing bone support for adjacent teeth and unerupted teeth, and providing stable dental arch maxilla (Jensen and Stevens, 2020; Kato et al, 2021). Regarding cleft defects treatment, autogenous iliac cancellous bone graft has become the ideal treatment for the repair of alveolar cleft, providing abundant cancellous bone (Vura et al, 2020; Mahardawi et al, 2021).…”