Postnatal Craniofacial Skeleton Development following a Pushback Operation of Patients with Cleft Palate

Abstract

A longitudinal growth study of the craniofacial skeleton in 52 (19 males, 33 females) Danish individuals with cleft palates was performed. Thirty (13 males, 17 females) had clefts of the soft palate only or clefts extending into the posterior third of the hard palate. Twenty-two (6 males, 16 females) had more extensive clefts including up to two-thirds of the hard palate. The cleft was closed with a pushback operation at 22 months of age. Orthodontic treatment was included in the early mixed dentition. Lateral cephalometries were obtained at 5, 8, 12, 16, and 21 years of age. Twenty-four variables were digitized and analyzed. The results indicated that patients with more extensive clefts demonstrated significantly smaller anterior cranial base length (N-S), total cranial base length (N-Ba), maxillary dentoalveolar base length (A-PMP), mandibular length (Cd-Pgn), upper anterior and posterior facial heights (N-ANS and P-PMP), and total facial height (N-Gn). Patients with the more extensive clefts reached maximum growth spurt later than patients with less extensive clefts in all dimensions except the A-PMP and the lower and total facial heights.

The Need for Orthognathic Surgery in Nonsyndromic Patients with Repaired Isolated Cleft Palate

“…However, patients with the most extensive clefts at birth have been reported by various authors to have the most marked deviations in craniofacial morphology, namely a smaller and more retrusive maxilla, both at an early age and in adulthood (Jonsson and Thilander, 1979;ˇSmahel, 1984;Viteporn et al, 1991;Heli¨ovaara and Ranta, 1993;Becker et al, 2001). The extent of the palatal cleft was not possible to ascertain in the present sample.…”

Clinical Application of Hyperdry Amniotic Membrane in Cleft Palate Repair

“…A major disadvantage of it is scar contraction on the alveolar process of the maxilla associated with the raw wound produced by the pushback procedure. 1 Severe scar contraction may cause remarkable retardation of maxillary growth. 2 For these reasons, some surgeons prefer palatoplasty without pushback as typified by Bardach two-flap palatoplasty 3 in order to prevent raw wounding of the palate.…”