To study early changes in cleft size and maxillary arch dimensions and to evaluate these changes in relation to performed surgical procedures.
Design
Retrospective longitudinal study.
Setting
The Cleft Lip and Palate Center, Uppsala University Hospital, Sweden.
Patients
Dental study models of 79 consecutive children (28 with unilateral cleft lip and palate, 39 with cleft palate, and 12 with Pierre Robin sequence) were analyzed.
Interventions
Lip repair at 3 to 4 months, soft palate repair at 6 to 10 months, and hard palate repair at 25 to 26 months of age.
Main Outcome Measures
Cleft size was measured before each surgical intervention up to 2 years and arch dimensions were measured before each surgical intervention and at 5 years.
Results
Cleft widths decreased from infancy up to 2 years, but the anteroposterior cleft length in cleft palate was unchanged. Arch widths between cuspid points (C-C1) and tuberosity points (T-T1) and also the change over time in C-C1 and T-T1 differed significantly between the groups from infancy up to 5 years.
Conclusions
Cleft widths decreased after lip closure and/or soft palate closure. The children with unilateral cleft lip and palate had wider maxillary arch dimensions than the children with cleft palate or Pierre Robin sequence during the first years of life, but after hard palate closure the transverse growth was reduced in the children with unilateral cleft lip and palate. At 5 years the children with unilateral cleft lip and palate had similar maxillary widths as the children with cleft palate and/or Pierre Robin sequence.
AdussH.PruzanskyS.Width of cleft at level of the tuberosities in complete unilateral cleft lip and palate. Plast Reconstr Surg.1968; 41: 113–123.
2.
AnderssonE.M.SandvikL.SembG.AbyholmF.Palatal fistulas after primary repair of clefts of the secondary palate. Scand J Plast Reconstr Surg Hand Surg.2008; 42: 296–299.
3.
AthanasiouA.E.MazaheriM.ZarrinniaK.Frequency of crossbite in surgically treated cleft lip and/or palate children. J Pedod.1986; 10: 340–351.
4.
AthanasiouA.E.MazaheriM.ZarrinniaK.Longitudinal study of the dental arch dimensions in hard and soft palate clefts. J Pedod.1987; 12: 35–47.
5.
AthanasiouA.E.MazaheriM.ZarrinniaK.Dental arch dimensions in patients with unilateral cleft lip and palate. Cleft Palate J.1988; 25: 139–145.
6.
BraumannB.KeiligL.Stellzig-EisenhauerA.BourauelC.BergeS.JagerA.Patterns of maxillary alveolar arch growth changes of infants with unilateral cleft lip and palate: preliminary findings. Cleft Palate Craniofac J.2003; 40: 363–372.
7.
da Silva FilhoO.RamosA.AbdoR.The influence of unilateral cleft lip and palate on maxillary dental arch morphology. Angle Orthod.1992; 62: 283–290.
8.
DahlE.HanusardottirB.BerglandO.A comparison of occlusions in two groups of children whose clefts were repaired by three different surgical procedures. Cleft Palate J.1981; 18: 122–127.
9.
DiBiaseA.T.DiBiaseD.D.HayN.J.SommerladB.C.The relationship between arch dimensions and the 5-year index in the primary dentition of patients with complete UCLP. Cleft Palate Craniofac J.2002; 39: 635–640.
10.
DoganS.OncagG.AkinY.Craniofacial development in children with unilateral cleft lip and palate. Br J Oral Maxillofac Surg.2006; 44: 28–33.
11.
FriedeH.PerssonE.C.LiljaJ.ElanderA.Lohmander-AgerskovA.SoderpalmE.Maxillary dental arch and occlusion in patients with repaired clefts of the secondary palate. Influence of push back palatal surgery. Scand J Plast Reconstr Surg Hand Surg.1993; 27: 297–305.
12.
GarrahyA.MillettD.T.AyoubA.F.Early assessment of dental arch development in repaired unilateral cleft lip and unilateral cleft lip and palate versus controls. Cleft Palate Craniofac J.2005; 42: 385–391.
13.
HeidbuchelK.L.Kuijpers-JagtmanA.M.Maxillary and mandibular dental-arch dimensions and occlusion in bilateral cleft lip and palate patients from 3 to 17 years of age. Cleft Palate Craniofac J.1997; 34: 21–26.
14.
HeidbuchelK.L.Kuijpers-JagtmanA.M.KramerG.J.Prahl-AndersenB.Maxillary arch dimensions in bilateral cleft lip and palate from birth until four years of age in boys. Cleft Palate Craniofac J.1998; 35: 233–239.
15.
HenrikssonT.G.SkoogV.T.Identification of children at high anaesthetic risk at the time of primary palatoplasty. Scand J Plast Reconstr Surg Hand Surg.2001; 35: 177–182.
16.
HondaY.SuzukiA.OhishiM.TashiroH.Longitudinal study on the changes of maxillary arch dimensions in Japanese children with cleft lip and/or palate: infancy to 4 years of age. Cleft Palate Craniofac J.1995; 32: 149–155.
17.
HuangC.S.WangW.I.LiouE.J.ChenY.R.ChenP.K.NoordhoffM.S.Effects of cheiloplasty on maxillary dental arch development in infants with unilateral complete cleft lip and palate. Cleft Palate Craniofac J.2002; 39: 513–516.
18.
JakobssonO.P.PontenB.Closure of the cleft palate in one or two stages: the surgical methods. Scand J Plast Reconstr Surg Hand Surg.1990; 24: 149–155.
19.
KozeljV.The basis for presurgical orthopedic treatment of infants with unilateral complete cleft lip and palate. Cleft Palate Craniofac J.2000; 37: 26–32.
20.
KramerG.J.HoeksmaJ.B.Prahl-AndersenB.Palatal changes after lip surgery in different types of cleft lip and palate. Cleft Palate Craniofac J.1994; 31: 376–384.
21.
KramerG.J.HoeksmaJ.B.Prahl-AndersenB.Early palatal changes after initial palatal surgery in children with cleft lip and palate. Cleft Palate Craniofac J.1996a; 33: 104–111.
22.
KramerG.J.HoeksmaJ.B.Prahl-AndersenB.Prediction of early palatal growth and development in children with cleft lip and palate. Cleft Palate Craniofac J.1996b; 33: 112–117.
23.
LoL.WongF.ChenY.LinW.KoE.Palatal surface area measurement: comparisons among different cleft types. Ann Plast Surg.2003; 50: 18–24.
24.
Lohmander-AgerskovA.Speech outcome after cleft palate surgery with the Goteborg regimen including delayed hard palate closure. Scand J Plast Reconstr Surg Hand Surg.1998; 32: 63–80.
25.
MarsM.HoustonW.J.A preliminary study of facial growth and morphology in unoperated male unilateral cleft lip and palate subjects over 13 years of age. Cleft Palate J.1990; 27: 7–10.
26.
MazaheriM.AthanasiouA.E.LongR.E.JrKolokithaO.G.Evaluation of maxillary dental arch form in unilateral clefts of lip, alveolus, and palate from one month to four years. Cleft Palate Craniofac J.1993; 30: 90–93.
27.
MazaheriM.HardingR.L.CooperJ.A.MeierJ.A.JonesT.S.Changes in arch form and dimensions of cleft patients. Am J Orthod.1971; 60: 19–32.
28.
NystromM.RantaR.Effect of timing and method of cleft palate repair on dental arches at the age of three years. Cleft Palate J.1990; 27: 349–352.
29.
ParwazM.A.SharmaR.K.ParasharA.NandaV.BiswasG.MakkarS.Width of cleft palate and postoperative palatal fistula—do they correlate?J Plast Reconstr Aesthet Surg.2009; 62: 1559–1563.
30.
PinheiroJ.BatesD.Mixed-Effects Models in S and S-PLUS. Statistics and Computing.New York: Springer-Verlag;2000.
31.
ReiserE.SkoogV.T.GerdinB.Andlin-SobockiA.Association between cleft size and crossbite in children with cleft palate and unilateral cleft lip and palate. Cleft Palate Craniofac J.2010; 47: 175–181.
32.
RintalaA.E.RantaR.Spontaneous narrowing of the palatal cleft during the first year of life: a quantitative study. Scand J Plast Reconstr Surg Hand Surg.1987; 21: 35–38.
33.
RobertsonN.R.FishJ.Early dimensional changes in the arches of cleft palate children. Am J Orthod.1975; 67: 290–303.
RossR.B.Treatment variables affecting facial growth in complete unilateral cleft lip and palate. Cleft Palate J.1987; 24: 5–77.
36.
SchwartzB.H.LongR.E.JrSmithR.J.GipeD.P.Early prediction of posterior crossbite in the complete unilateral cleft lip and palate. Cleft Palate J.1984; 21: 76–81.
37.
SkoogT.Repair of unilateral cleft lip deformity: maxilla, nose and lip. Scand J Plast Reconstr Surg.1969; 3: 109–133.
38.
Van LierdeK.M.MonstreyS.BonteK.Van CauwenbergeP.VinckB.The long-term speech outcome in Flemish young adults after two different types of palatoplasty. Int J Pediatr Otorhinolaryngol.2004; 68: 865–875.
39.
WadaT.MiyazakiT.Growth and changes in maxillary arch form in complete unilateral cleft lip and cleft palate children. Cleft Palate J.1975; 12: 115–130.
40.
WadaT.MizokawaN.MiyazakiT.ErgenG.Maxillary dental arch growth in different types of cleft. Cleft Palate J.1984; 21: 180–192.
41.
WitzelM.A.SalyerK.E.RossR.B.Delayed hard palate closure: the philosophy revisited. Cleft Palate J.1984; 21: 263–269.
