One- or Two-Stage Palate Closure in Patients with Unilateral Cleft Lip and Palate: Comparing Cephalometric and Occlusal Outcomes

Abstract

Objective:

To assess facial growth and dentoalveolar development in two groups of patients with complete unilateral cleft lip and palate. Primary surgical treatment differed in the timing of hard palate closure.

Design:

Forty-three patients with unilateral cleft lip and palate were examined. Twenty-two patients underwent early one-stage closure of the hard and soft palate cleft (mean age 23.0 ± 4.7 months); in 21 patients, the hard palate closure was delayed to 86.3 ± 39.2 months of age. Lateral cephalograms and dental casts were consecutively analyzed at four stages between 6 and 18 years of age.

Results:

Lateral cephalometric analysis revealed no significant intergroup differences in the sagittal and vertical craniofacial dimensions at any time. Dental cast analysis showed constriction of the upper anterior arch width at the ages of 6 and 10 years in patients with one-stage surgical palate closure, but a difference could no longer be verified at the ages of 15 and 18 years.

Conclusions:

The transverse distances in the upper jaw developed initially more positively in the group with delayed hard palate closure, but it became apparent later that the transverse deficiency after one-stage palate closure could be compensated for. When considering surgical treatment in general, the advantages of the delayed hard palate closure must be weighed against criteria favoring the early one-stage closure of the hard and soft palate.

Keywords

cephalometric analysis delayed hard palate closure dental cast analysis long-term study unilateral cleft lip and palate

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References

Bardach

Morris

H.L.

Olin

W.H.

Late results of primary veloplasty: the Marburg project.

Plast Reconstr Surg. 1978; 73: 207–215.

Bardach

Roberts

D.M.

Yale

Rosewall

Mooney

The influence of simultaneous cleft lip and palate repair on facial growth in rabbits.

Cleft Palate J. 1980; 17: 309–318.

Bishara

S.E.

de Arrendondo

R.S.M.

Vales

H.P.

Jakebson

J.R.

Dentofacial relationships in persons with unoperated clefts: comparison between 3 cleft types.

Am J Orthod. 1985; 87: 481–507.

Friede

Enemark

Long term evidence for favorable midfacial growth after delayed hard palate repair in ULCP patients.

Cleft Palate Craniofac J. 2001; 38: 323–329.

Friede

Lilja

Johanson

Cleft lip and palate treatment with delayed closure of the hard palate. A preliminary report.

Scand J Plast Reconstr Surg. 1980; 14: 49–53.

Friede

Möller

Lilja

Lauritzen

Johanson

Facial morphology and occlusion at the stage of early mixed dentition in cleft lip and palate patients treated with delayed closure of the hard palate.

Scand J Plast Reconstr Surg. 1987; 21: 65–71.

Friede

Priede

Möller

Maulina

Lilja

Barkane

Comparisons of facial growth in patients with unilateral cleft lip and palate treated by different regimens for two-stage palatal repair.

Scand J Plast Reconstr Surg Hand Surg. 1999; 33: 73–81.

Gaggl

Feichtinger

Schultes

Santler

Pichlmaier

Mossböck

Kärcher

Cephalometric and occlusal outcome in adults with unilateral cleft, lip, palate and alveolus after two different surgical techniques.

Cleft Palate Craniofac J. 2003; 40: 249–255.

Gillies

H.D.

Fry

W.K.

A new principle in the surgical treatment of “congenital cleft palate” and its mechanical counterpart.

Br Med J. 1921; 1: 335–338.

10.

Gnoinski

Orofacial development up to age 15 in complete unilateral cleft lip and palate cases treated according to the Zürich concept. In: Pfeifer

, ed. Craniofacial Abnormalities and Clefts of the Lip, Alveolus and Palate. Fourth Hamburg International Symposium. Stuttgart: Thieme; 1991: 270–272.

11.

Graber

T.M.

Craniofacial morphology in cleft palate and cleft lip deformities.

Surg Gynecol Obstet. 1949; 88: 359–369.

12.

Härle

Minimum documentation of clefts of the lip, jaw and palate. An interdisciplinary commission's proposal.

Dtsch Z Mund Kiefer Gesichtschir. 1989; 13: 21–22.

13.

Horch

H.H.

Fortschritte und Schwerpunkte bei der komplexen Behandlung von Lippen-Kiefer-Gaumenspalten. In: Scheunemann

Schwenzer

Busch

, eds. Fortschritte der Kiefer- und Gesichts-Chirurgie, Mund- Kiefer- und Gesichtschirurgie. Stuttgart, New York: Thieme; 1990: 36–43.

14.

Hotz

M.M.

Gnoinski

W.M.

Nussbaumer

Kistler

Early orthopedics in CLP cases: guidelines for surgery.

Cleft Palate J. 1978; 15: 405–411.

15.

Joos

Skeletal growth after muscular reconstruction for cleft lip, alveolus, and palate.

Br J Oral Maxillofac Surg. 1995; 33: 139–144.

16.

Kitagawa

Kohara

Sohmura

Takahashi

Tachimura

Wada

Kogo

Dentoalveolar growth of patients with complete unilateral cleft lip and palate by early two-stage Furlow and push-back method: preliminary results.

Cleft Palate Craniofac J. 2004; 41: 519–525.

17.

Koberg

Koblin

Speech development and maxillary growth in relation to technique and timing of palatoplasty.

J Maxillofac Surg. 1973; 1: 44–50.

18.

Korkhaus

Gebiβ-, Kiefer- und Gesichtsorthopädie. In: Bruhn

, ed. Handbuch der Zahnheilkunde. Vol. IV. München: Bergmann; 1939: 62.

19.

Molsted

Treatment outcome in cleft lip and palate: issues and perspectives.

Crit Rev Oral Biol Med. 1999; 10: 225–239.

20.

Nollet

P.J.P.M.

Katsaros

van't Hof

M.A.

Semb

Shaw

W.C.

Kuijpers-Jagtman

A.M.

Treatment outcome after two-stage palatal closure in unilateral cleft lip and palate: a comparison with Eurocleft.

Cleft Palate Craniofac J. 2005; 42: 512–516.

21.

Noverraz

A.E.M.

Kuijpers-Jagtman

A.M.

Mars

van't Hof

M.A.

Timing of hard palate closure and dental arch relationships in unilateral cleft lip and palate patients: a mixed-longitudinal study.

Cleft Palate Craniofac J. 1993; 30: 391–396.

22.

Panagiotidis

Witt

Der individualisierte ANB-Winkel.

Fortschr Kieferorthop. 1977; 38: 408–416.

23.

Rakosi

An Atlas and Manual of Cephalometric Radiography. London: Wolfe Medical Publications Ltd; 1982.

24.

Rakosi

Jonas

Graber

Orthodontic—Diagnosis. Vol. 11. Stuttgart, New York: Thieme; 1993.

25.

Rohrich

R.J.

Love

E.J.

Byrd

Johns

D.F.

Optimal timing of cleft palate closure.

Plast Reconstr Surg. 2000; 106: 413–421.

26.

Ross

R.B.

Treatment variables affecting facial growth in complete unilateral cleft lip and palate. Part 5: timing of palate repair.

Cleft Palate J. 1987a; 24: 54–63.

27.

Ross

R.B.

Treatment variables affecting facial growth in complete unilateral cleft lip and palate. Part 7: an overview of treatment and facial growth.

Cleft Palate J. 1987b; 24: 71–77.

28.

Schwarz

A.M.

Röntgenostatik. Wien: Urban Schwarzenberg; 1958.

29.

Schweckendieck

Zur zweiphasigen Gaumenspaltenoperation bei primärem Velumverschluβ. In: Schuchardt

Wassmund

, eds. Fortschritte Kiefer- und Gesichtschirurgie. Jb. Vol. I. Stuttgart: Thieme; 1955: 73–76.

30.

Shapira

Lubit

Kuftinec

M.M.

Borell

The distribution of clefts of the primary and secondary palates by sex, type and locations.

Angle Orthod. 1999; 69: 523–528.

31.

Shaw

W.C.

Dahl

Asher-McDade

Brattström

Mars

McWilliam

Molsted

Plint

D.A.

Prahl-Andersen

Roberts

Semb

The

R.P.S.

A six-center international study of treatment outcome in patients with clefts of the lip and palate: part 5. General discussion and conclusions.

Cleft Palate Craniofac J. 1992; 29: 413–418.

32.

Witzel

M.A.

Salyer

K.E.

Ross

R.B.

Delayed hard palate closure: the philosophy revisited.

Cleft Palate J. 1984; 21: 263–269.