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.

Facial Growth at 5 and 10 Years After Veau-Wardill-Kilner Versus Minimal-Incision Technique Repair of Isolated Cleft Palate

“…Comparing the 2 surgical methods and the 2 cleft lengths, the mandibular length was significantly shorter in children having a big cleft and operated with the minimal incision technique (group M2) (Figure 2A). This is in agreement with Viteporn et al (1991) who showed that patients with total clefts had the shortest mandibular lengths. The M2 group was the biggest and whether the smaller mandible in this group at 5 years was due to the surgical intervention (or length of cleft) or to the material of isolated cleft palate is unclear.…”

Minimal incision palatoplasty with or without muscle reconstruction in patients with isolated cleft palate—a cephalometric study at 5 and 10 years

“…The smaller mandible found in the groups with big clefts supports a previous study, where patients with total clefts had shorter mandibular lengths (155). The restriction of the posteriorly vertical growth of the palate, showed by the posterior inclination of the maxilla and the reduced posterior upper face height at the age of 10 years after the use of the muscle reconstruction, seems similar to the findings at 9 and 14 years of treated Japanese children with submucous ICP (110).…”

One-stage closure of isolated cleft palate with the Veau-Wardill-Kilner V to Y pushback procedure or the Cronin modification: III. Comparison of lateral craniofacial morphology

“…This is in accordance with Dahl (3), who studied 57 adult men with ICP and found that with regard to mandibular size, shape, and position the two subgroups, divided by extent of cleft, exhibited great similarity. Smahel (19) and Viteporn et al (20) reached different conclusions: subjects with soft-palate clefts have the shortest mandibular lengths (19), in contrast to an observation in which the shortest mandibular lengths occur with total clefts (20).…”

“…In the present study the distance Ans-Pm was not affected by the cleft type, whereas the distance Ss-Ss' was significantly shorter in the complete cleft group. Viteporn et al (20) studied 52 Danish cleft palate patients from 5 to 21 years old and report a smaller maxillary dentoalveolar base length in patients with most extensive clefts. There were no significant findings in the mandible with regard to cleft extent.…”