LETTER TO THE EDITOR

Year : 2021  |  Volume : 8  |  Issue : 1  |  Page : 80-81

Cephalometric evaluation of skeletal base relationship in patients with cleft lip and palate in a tertiary hospital in South India

Isha Duggal, Aditya Talwar, Ritu Duggal
Division of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Dr. Isha Duggal
Division of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi - 110 029
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jclpca.jclpca_40_20

1. The authors state that “UCLP/BCLP patients recruited in the study were surgically treated at the appropriate age.” However, in the inclusion criteria, there is no mention about number of surgeries or a uniform surgical protocol followed by the operator(s), all of which can affect the treatment outcome^[2]
2. The mean age of patients with cleft is mentioned as 12.18 ± 2.77 years and 13.35 ± 1.99 years for the control group. Thus, the results largely apply to a prepubertal population which might be a limitation of the present study
3. Furthermore, while the overall sample size is considerable, it seems to be inadequate (subgroups: >9 years, >12 years, >14 years, and 16 years where the sample size is < 6 patients) to derive a statistically significant conclusion and extrapolate the results to the general population
4. It is noted in UCLP/BCLP assessment that tracing of point A is particularly difficult.^[3] This difficulty is usually overcome by more number of observers doing/repeating the cephalometric measurements. Subsequently, inter/intra-rater reliability could have been incorporated in the present study^[4]
5. The study concludes that the mandible is retropositioned and retrognathic in cleft patients as determined by NPerp-Pog and Npog-FH. However, it would be pertinent if these values are correlated with the cranial base flexure and growth pattern of the individual to truly determine if the retrognathism is due to growth rotation or deficiency in mandibular length.^[5]

References

1.	Johnson MK, Kuriakose MJ, Varma NS, Ajith VV, Subash P. Cephalometric evaluation of skeletal base relationship in patients with cleft lip and palate in a tertiary hospital in South India. J Cleft Lip Palate Craniofac Anom 2020;7:89.
2.	Brattström V, Mølsted K, Prahl-Andersen B, Semb G, Shaw WC. The Eurocleft study: Intercenter study of treatment outcome in patients with complete cleft lip and palate. Part 2: Craniofacial form and nasolabial appearance. Cleft Palate Craniofacial J 2005;42:69-77.
3.	Bongaarts CA, van't Hof MA, Prahl-Andersen B, Kuijpers-Jagtman AM. Identification of cephalometric landmarks in unilateral cleft lip and palate patients: Are there alternatives for point A, ANS, and PNS? Cleft Palate Craniofac J 2008;45:81-6.
4.	Durão AR, Pittayapat P, Rockenbach MI, Olszewski R, Ng S, Ferreira AP, et al. Validity of 2D lateral cephalometry in orthodontics: A systematic review. Prog Orthod 2013;14:31.
5.	Bhattacharya A, Bhatia A, Patel D, Mehta N, Parekh H, Trivedi R. Evaluation of relationship between cranial base angle and maxillofacial morphology in Indian population: A cephalometric study. J Orthod Sci 2014;3:74-80.