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

Abstract

Objective To examine skeletal morphology and dental arch relationships at 8 years of age following early 2-stage palatoplasty, which consists of soft palate plasty at 1 year of age and hard palate closure at 1.5 years of age, and to compare the results with those of conventional pushback palatoplasty. Design Retrospective. Setting Single institutional study. Patients Eighty-six patients with nonsyndromic complete unilateral cleft lip and palate (UCLP) were selected. Intervention The subjects were divided into 2 groups according to the palatoplasty protocols, as follows: 45 patients, who underwent early 2-stage palatoplasty (ETS group), and 41 patients, who underwent 1-stage pushback palatoplasty (PB group). Main Outcome Measures Skeletal morphology was assessed using lateral cephalometric analysis, and dental arch relationships were examined using the GOSLON yardstick. Results Cephalometric analysis revealed that the anterior-posterior length of the maxilla, measured by PTM-A and PTM-ANS, both projected to the nasal floor (NF) plane, was longer in the ETS group than in the PB group (PTM-A/NF, p = .04; PTM-ANS/NF, p = .03, unpaired t-test), although no significant difference was observed in SNA ( p = .09, unpaired t-test). Upper posterior facial height was shorter in the ETS group than in the PB group ( p = .02, unpaired t). Assessments with the GOSLON yardstick showed that the ETS group presented better dental arch relationships than the PB group ( p = 0.04, Mann–Whitney's U-test). Conclusions The present results suggested that the ETS protocol reduced the negative effects of palatal surgery on facial development and dental arch relationships in patients with complete UCLP at 8 years of age.

A systematic review of differences in outcome between one and two stage palate repair in cleft lip and palate

“…The latter, however, only noticed a difference in transversal growth and not in sagittal growth. Otsuki et al (33) found longer anterior-posterior length of the maxilla, lower posterior facial height, larger angle between the nasal floor plane and the SN plane, and better GOSLON yardstick scores in the two-stage group. They conclude that the two-stage approach resulted in better dental relationships and anterior-posterior maxillary growth than the one-stage protocol.…”

“…Facial growth was reported in six original studies. Three of these were Randomized controlled trials (RCT) within the Scandcleft trials (28)(29)(30), one was an independent RCT (31), and two were non-RCTs (32,33). It is worth observing that the studies that are part of the Scandcleft trials all included the same patient population, although the number of patients lost to follow-up differed slightly.…”

“…Three out of six showed an advantage for the two-stage group. However, these three studies (31)(32)(33) were rather small (n = 64, n = 68, and n = 86, respectively) and follow-up was limited to between 5 and 8 years of age. Furthermore, in one of them (32) differences were only found for transversal growth.…”