Facial Growth in Adulthood after Primary Periosteoplasty or Primary Bone Grafting in UCLP

Abstract

Objective

The primary research aim of this study was to compare long-term differences in craniofacial morphology at adulthood between two groups of unilateral cleft lip and palate (UCLP) patients: one operated by primary periosteoplasty and the other by primary bone grafting.

Design

The two groups were followed longitudinally at 5-year intervals; this study examined the 15- to 20-year age range.

Setting

University hospital/center located in Prague, Bohemia, Czech Republic.

Patients

17 men with primary bone grafting, 29 men with primary periosteoplasty.

Interventions

Primary bone grafting or periosteoplasty.

Methods

Serial cephalometric radiographs.

Main outcome Measures

Conventional cephalometric and finite element measures.

Results

The mandibular symphysis was larger in the bone-grafted group. The periosteoplasty group displayed a more horizontal growth of the mandible with less rotation than the bone-grafted group. There were no other significant differences.

Conclusions

We conclude that the original outcomes differences observed in childhood and adolescence were masked by skeletal and dental compensations in adulthood. These observations can be attributed to both natural growth and clinical intervention.

Keywords

facial growth finite element outcomes primary bone grafting primary periosteoplasty unilateral cleft lip and palate

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References

Battagel

J.M.

Facial growth of males and females compared by tensor analysis.

Br J Orthod 1994; 21: 245–257.

Behrents

R.G.

Atlas of Growth in the Aging Craniofacial Skeleton. Monograph 18. Craniofacial Growth Series. Carlson

D.S.

Ribbens

K.A.

eds. Ann Arbor, MI: Center for Human Growth and Development; 1986.

Brattström

McWilliam

Larson

Semb

Craniofacial development in children with unilateral cleft of the lip, alveolus, andpalate treated according to four different regimes.

Scand J Plast Reconstr Hand Surg. 1991; 25: 259–267.

Cangialosi

Moss

M.L.

McAlarney

M.E.

Nirenblatt

B.D.

Yuan

An evaluation of growth changes and treatment effects in class II division I malocclusion with conventional roentgenographic cephalometry and finite element method analysis.

Am J Orthod Dentofac Orthop. 1994; 105: 153–160.

Drahorádová

Müllerová

Šmahel

Changes of craniofacial growth and development in males with complete unilateral cleft lip and palate between the age of 5 to 20 years.

Acta Chir Plast. 1997; 39: 82–87.

Enemark

Bolund

Jorgensen

Evaluation of unilateral cleft lip and palate treatment: long term results.

Cleft Palate Craniofac J. 1990; 27: 354–361.

Franchi

Baccetti

McNamara

J.A.

Shape-coordinate analysis of skeletal changes induced by rapid maxillary expansion and facial mask therapy.

Am J Orthod Dentofac Orthop. 1998; 114: 418–426.

Friede

Johanson

A follow-up study of cleft children treated with primary bone grafting I. Orthodontic aspects.

Scand J Plast Reconstr Surg. 1980; 8: 88–103.

Grasseschi

M.F.

In reply to: Suzuki, et al. Cephalometric comparison of craniofacial morphology between primary bone-grafted and nongrafted complete unilateral cleft lip and palate adults.

Cleft Palate Craniofac J. 1997; 36: 177.

10.

Horswell

B.B.

Levant

B.A.

Craniofacial growth in unilateral cleft lip and palate: skeletal growth from eight to eighteen years.

Cleft Palate Craniofac J. 1988; 25: 114–121.

11.

Robertson

N.R.E.

Jolleys

An 11-year follow-up of the effects of early bone grafting in infants born with complete cleft lip and palate.

Brit J Plastic Surg. 1983; 36: 438–443.

12.

Rosenstein

S.W.

Jacobson

B.N.

Monroe

C.W.

Griffith

B.H.

A series of cleft lip and palate children five years after undergoing orthopedic and bone grafting procedure.

Scand J Plast Reconstr Surg. 1972; 42: 33–50.

13.

Rosenstein

S.W.

Monroe

C.W.

Jacobson

B.N.

Kernahan

D.A.

Griffith

B.H.

Bauer

B.S.

The case for early bone grafting in cleft lip and cleft palate.

Plast Reconstr Surg. 1982; 70: 297–309.

14.

Ross

Early and late periosteoplasty in cleft lip and palate.

Br J Plast Surg. 1987; 265: 120.

15.

Sameshima

G.T.

Banh

Šmahel

Melnick

Primary periosteoplasty and primary bone grafting in unilateral cleft lip and palate: a comparison of facial growth and development using finite element analysis.

Cleft Palate Craniofac J. 1996; 33: 300–305.

16.

Sameshima

G.T.

Melnick

Finite element-based cephalometric analysis.

Angle Orthod. 1994; 64: 343–350.

17.

Semb

A study of facial growth in patients with unilateral cleft lip and palate treated by the Oslo CLP team.

Cleft Palate Craniofac J. 1991; 28: 1–20.

18.

Singh

G.D.

McNamara

J.A.

Lozanoff

Finite element analysis of the cranial base in subjects with class III malocclusion.

Brit J Orthod. 1997; 24: 103–112.

19.

Singh

G.D.

McNamara

J.A.

Lozanoff

Mandibular morphology in subjects with class III malocclusions: finite-element morphometry.

Angle Orthod. 1998; 68: 409–418.

20.

Šmahel

Müllerová

Craniofacial morphology in unilateral cleft lip and palate.

Cleft Palate J. 1986; 23: 225–232.

21.

Šmahel

Müllerová

Effects of primary periosteoplasty of facial growth in unilateral cleft lip and palate: 10-year follow-up.

Cleft Palate J. 1988; 25: 356–361.

22.

Šmahel

Müllerová

Nejedly

Horak

Changes in craniofacial development due to modifications of the treatment of unilateral cleft lip and palate.

Cleft Palate Craniofac J. 1998; 35: 240–247.

23.

Šmahel

Machová

Müllerová

Škvařilová

Growth and development of the face in complete unilateral cleft lip and palate during prepubertal and pubertal periods.

Acta Chir Plast. 1992; 34: 163–177.

24.

Šmahel

Betincová

Müllerová

Škvařilová

Facial growth and development in unilateral complete cleft lip and palate from palate surgery up to adulthood.

J Craniofac Genet Dev Biol. 1993; 13: 57–71.

25.

Šmahel

Müllerová

Facial growth and development in unilateral cleft lip and palate during the period of puberty: comparison of the development after periosteoplasty and after primary bone grafting.

Cleft Palate Craniofac J. 1994; 31: 106–115.

26.

Šmahel

Škvařilová

Roetgenocephalometric study of cranial interrelations.

J Craniofac Genet Dev Biol. 1988; 8: 303–318.

27.

Suzuki

Goto

Nakamura

Honda

Ohishi

Tashiro

Fujino

Cephalometric comparison of craniofacial morphology between primary bone-grafted and nongrated complete unilateral cleft lip and palate adults.

Cleft Palate Craniofac J. 1996; 33: 429–434.

28.

Trotman

C.A.

Ross

R.B.

Craniofacial growth in bilateral cleft lip and palate: ages six years to adulthood.

Cleft Palate Craniofac J. 1993; 30: 261–273.

29.

Trotman

C.A.

Long

Jr Rosenstein

S.W.

Murphy

Johnston

Jr . Comparison of facial form in primary alveolar bone-grafted and nongrafted unilateral cleft lip and palate patients: intercenter retrospective study. Cleft Palate Craniofac J. 1996; 33: 91–95.

30.

Wood

R.J.

Grayson

B.H.

Cutting

C.B.

Gingivoperiosteoplasty and midfacial growth.

Cleft Palate Craniofac J. 1997; 34: 363–364.