Long-term mid-facial growth of patients with a unilateral complete cleft of lip, alveolus and palate treated by two-stage palatoplasty: cephalometric analysis

Abstract

ObjectivesThe aim of this study is to evaluate long-term facial growth in adults previously treated for an isolated unilateral complete cleft lip, alveolus and palate by two-stage palatoplasty.Materials and methodsUnilateral cleft lip and palate (UCLP) patients of 17 years and older treated by two-stage palatoplasty were invited for long-term follow-up. During follow-up, lateral cephalograms were obtained (n = 52). Medical history was acquired from their medical files. Outcome was compared to previously published normal values and the Eurocleft study.ResultsSoft and hard palate closure were performed at the age of 8 (SD 5.9) months and 3 (SD 2.2) years, respectively. The mean maxillary and mandibular angle (SNA, SNB) were 74.9° (SD 4.2) and 75.8° (SD 3.8). Maxillary and maxillomandibular relationships (SNA, ANB) were comparable to all Eurocleft Centres, except for Centre D. We observed a significantly steeper upper interincisor angle compared to the Eurocleft Centres.ConclusionsThis study describes the long-term craniofacial morphology in adults treated for a UCLP with hard palate closure at a mean age of 3 years. The mean maxillary angle SNA and mandibular angle SNPg were comparable to previous studies both applying early and delayed hard palate closure. The observed upper incisor proclination is likely caused by orthodontic overcorrection in response to the unfavourable jaw relationships. No clear growth benefit of this protocol could be demonstrated.Clinical relevanceThe present study shows the long-term craniofacial morphology of UCLP adults after the Utrecht treatment protocol which includes two-stage palate closure.

Effects of various surgical protocols on maxillofacial growth in patients with unilateral cleft lip and palate: a systematic review

“…On the one hand, they propose that there may be a potentially normal maxillary growth in untreated UCLP patients [15] , and on the other hand, they propose that regardless of the treatment, UCLP patients show retrusion of the maxilla and decreased maxillary length, where there are many causes to be considered. Some reports attribute this retrusion to the intrinsic defect of the cleft [16,17] , while others claim it is from surgical intervention [6,[13][14][15]19] and even dependent on the skill of the surgeon. The disturbing effect on the growth of the maxillary skeleton after surgical repair is due to devascularization, disturbance of the periosteum or the restrictive effect of the scar [16] .…”

“…The disturbing effect on the growth of the maxillary skeleton after surgical repair is due to devascularization, disturbance of the periosteum or the restrictive effect of the scar [16] . Therefore, surgery leads to maxillary hypoplasia: the maxillary angle (SNA) and the maxillomandibular angle (ANB) were smaller and negative when matched to the normal population [19] . Unoperated cleft patients had a more favorable morphology of craniofacial structures when compared with surgically treated patients, indicating that due to alteration of the peri-oral functional matrix, surgical intervention interferes with the growth process in UCLP patients.…”

“…There does not seem to be any consensus on the best time to perform palate closure, where every timing has its own advantages and disadvantages [7,20] . Some studies [15,19,21,22] assumed that the early surgical repair of the cleft palate is responsible for the impaired maxillary growth and concluded that it was better to delay surgical palate repair. During the maxillary growth spurt an important proportion of the final length of the maxilla is gained.…”

“…During the maxillary growth spurt an important proportion of the final length of the maxilla is gained. It is possible that the benefit of delayed hard palate on maxillofacial growth closure can only be achieved by closing when the greatest proportion of the final maxillary length is already achieved [19] . However, Zheng et al [16] claim that isolated surgery has minor effects on growth disturbances and conclude that early palatal closure should therefore be performed because it will not negatively affect maxillofacial growth.…”

Crescimento facial em indivíduos com fissura de lábio e palato unilateral completa (FLPUC): acompanhamento cefalométrico longitudinal

“…As técnicas cirúrgicas para reparo do palato podem apresentar diferentes desempenhos para fala e crescimento craniofacial em indivíduos com fissura(LEOW;LO, 2008). É sugerido que, em futuros protocolos de tratamento, não somente seja avaliada a idade no momento da cirurgia, mas também, uma minimização do tecido cicatricial com a finalidade de reduzir os distúrbios associados ao crescimento ao longo da vida(KAPPEN et al, 2017). Alguns protocolos de reabilitação nas cirurgias primárias foram verificados, tanto a idade no momento da cirurgia, quanto o fechamento do palato em fase única ou duas etapas, mas não foram encontradas diferenças estatísticas entre os protocolos abaixo até os 5.1 anos de idade(HELIÖVAARA et al, 2017).…”