|Year : 2020 | Volume
| Issue : 2 | Page : 133-134
The effect of surgical correction on craniofacial growth in unilateral cleft lip and palate patients: A prospective study
Department of Orthodontics, Manipal College of Dental Science, Manipal Academy of Higher Education, Manipal, Karnataka, India
|Date of Submission||16-Apr-2020|
|Date of Acceptance||30-Apr-2020|
|Date of Web Publication||31-Jul-2020|
Dr. Madhumitha Natarajan
Room 7, Second Floor, Dental OPD, MCODS, Manipal - 576 104, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Natarajan M. The effect of surgical correction on craniofacial growth in unilateral cleft lip and palate patients: A prospective study. J Cleft Lip Palate Craniofac Anomal 2020;7:133-4
|How to cite this URL:|
Natarajan M. The effect of surgical correction on craniofacial growth in unilateral cleft lip and palate patients: A prospective study. J Cleft Lip Palate Craniofac Anomal [serial online] 2020 [cited 2020 Dec 1];7:133-4. Available from: https://www.jclpca.org/text.asp?2020/7/2/133/291146
I commend the authors for conducting the prospective study among unilateral cleft palate patients aged 5–7 years. In A-P plane, unilateral cleft lip and palate (UCLP) patients commonly display skeletal Class III relation caused by a posterior displacement of a smaller maxilla. The authors of present study also found a reduced maxillary length (Co-A) but the posterior position of maxilla and skeletal base was not evaluated using specific cephalometric parameters (SNA, SNB, ANB, and Wits appraisal).
The benefits of two-stage palatoplasty procedures (like Bardach two flap technique) are restoration of oral function, velopharyngeal competence, and cleft repair. Several authors have attributed restricted downward and forward maxillary growth to scar tissue formation at vomero-premaxillary suture.,, Most of the maxillary growth happens during pubertal growth (6–10 year for girls and 8–14 for boys). This formed the basis for delayed hard palate closure at mean age of 13 years by Schweckendieck when maxillary length was completed and explained better long-term results obtained.
The restrictive effect of cleft lip on maxillary growth too cannot be ignored. Antonarakiset al., analyzed 58 UCLP and found 8 years old UCLP patients with a more deficient cleft lateral lip height displayed a shorter maxillary length, a less protruded maxilla, and a shorter anterior maxillary height than those with a less deficient cleft lateral lip height.
In the vertical plane, most cleft patients demonstrate a large palatal plane angle and vertical deficiency in posterior maxilla. Tomitaet al. showed those clefts width <4 mm before the palatoplasty showed neither the backward rotation of the palatal plane nor the vertical deficiency of the posterior maxilla compared with >4 mm cleft width. Thus, alveolar cleft width (immediately after cheiloplasty) was moderately related to facial heights, the size of mandible, and the palatal plane angle at T2 (at 6 years). Similar results of a higher lower anterior facial height were observed by authors of the present study but vertical deficiency in posterior maxilla was not confirmed using cephalometric measures such as upper posterior facial height and the palatal plane angle.
Larger differences in alveolar height was seen (between the cleft and noncleft sides) among > 4 mm cleft group than mild cleft (<4 mm) groups, causing a transversely canted occlusal plane at 6 years of age and resulting in a facial asymmetry later in adolescence. A similar finding of facial asymmetry was observed by authors of the present study but were not confirmed using study models to measure differences in alveolar height at canine and molar region of major and minor segments at 8 years and correlate results to cleft width.
Furthermore, the mandibular length was significantly smaller among the UCLP patients with (>4 mm) of the alveolar cleft than in those with a smaller cleft. The authors of the present study found a similar finding of smaller mandibular length (Co-Gn) among UCLP patients but were not correlated to cleft width.
Further longitudinal studies of maxillary growth in UCLP patients with wider clefts and CBCT assessment of condylar position in glenoid fossa position, ramal inclination, and chin position after unilateral cleft palate repair.
Manipal Academy of Higher Education (MAHE), Karnataka, India, for providing library and scientific journals for the preparation of commentary.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Gaggl A, Feichtinger M, Schultes G, Santler G, Pichlmaier M, Mossböck R, et al
. Cephalometric and occlusal outcome in adults with unilateral cleft lip, palate, and alveolus after two different surgical techniques. Cleft Palate Craniofac J 2003;40:249-55.
Holland S, Gabbay JS, Heller JB, O'Hara C, Hurwitz D, Ford MD, et al
. Delayed closure of the hard palate leads to speech problems and deleterious maxillary growth. Plast Reconstr Surg 2007;119:1302-10.
Friede H. The vomero-premaxillary suture – A neglected growth site in mid-facial development of unilateral cleft lip and palate patients. Cleft Palate J 1978;15:398-404.
Thilander B, Persson M, Adolfsson U. Roentgen-cephalometric standards for a Swedish population. A longitudinal study between the ages of 5 and 31 years. Eur J Orthod 2005;27:370-89.
Bardach J, Morris HL, Olin WH. Late results of primary veloplasty: The Marburg Project. Plast Reconstr Surg 1984;73:207-18.
Antonarakis GS, Tompson BD, Fisher DM. Preoperative cleft lip measurements and maxillary growth in patients with unilateral cleft lip and palate. Cleft Palate Craniofac J 2016;53:e198-207.
Tomita Y, Kuroda S, Katsura T, Watanabe T, Watanabe K, Fujihara S, et al
. Severity of alveolar cleft before palatoplasty affects vertical maxillofacial growth in 6-year-old patients with complete unilateral cleft lip and palate. Am J Orthod Dentofacial Orthop 2012;141:S102-9.