A Longitudinal Cephalometric Study From Age 5 to 18 Years on Individuals With Complete Bilateral Cleft Lip and Palate

Abstract

Development of the facial profile between age 5 and the end of pubertal growth in patients with complete bilateral cleft lip and palate was studied by means of cephalometric x-rays taken at the age of 5, 10 and 15 years as well as at the end of the growth period. All 29 patients had been treated according to the same plan and operated upon by the same surgeon. Values for the ANB angle are typically very high in 5 year old children, and then decrease to values corresponding to those of the general population by the end of the pubertal growth period. Vertical development maintains the initial pattern; no compensatory vertical excess was observed. Due to the wide range in all measurements, the value of age-related mean values in a patient sample is of little consequence for individuals but can point out tendencies. The multidisciplinary concept of maintaining the initially protrusive position of the premaxilla by means of a passive plate at the newborn and infant stage, as well as using surgical procedures with limited retrusive effect proved to be correct in the long run: At the young adult stage the angle ANB remained positive for almost all patients except for those with multiple tooth agenesis in the upper arch. A potential benefit of two-stage palate repair is seen in the neutral vertical development of the patients examined. This hypothesis is supported by comparison with other studies from the literature.

A two-centre study on facial morphology in patients with complete bilateral cleft lip and palate at nine years of age

“…2011; 40: 782-789 doi:10.1016/j.ijom.2011.02.029, available online at http://www.sciencedirect.com Only one study presented in the literature on CBCLP at the age of 9-10 years had a sample size of over 50 patients: the largest sample at this age is the Oslo sample with 57 patients 16 . In the other studies the sample size ranges from 11 13 to 29 6 . Some of the studies in Table 1 are longitudinal observational studies, following their sample from 1 month 10 until adulthood, and presenting data at 9 years of age 6,8,16,22 .…”

“…In the other studies the sample size ranges from 11 13 to 29 6 . Some of the studies in Table 1 are longitudinal observational studies, following their sample from 1 month 10 until adulthood, and presenting data at 9 years of age 6,8,16,22 . Certain studies compared their group with normative data for a noncleft population 8,9,13,16,19,22 , or with the protocols of other centres 5,8 .…”

“…For CBCLP only 10 studies could be identified that report cephalometric data at the target age. Table 1 gives an overview of these studies 5,6,[8][9][10]13,15,16,19,22 . Int.…”

Initial growth pattern of children with cleft before alveolar bone graft stage according to cleft type

“…In addition, patients with cleft are known to have a more vertical growth pattern than noncleft normal patients 3,[8][9][10][11][12][13][14] and to maintain their initial vertical pattern during growth. 15 To investigate more specifically the initial growth pattern of patients with cleft, the samples need to be limited as follows: (1) unilateral cleft type and cleft hard palate only type, because these types seem to have less complicated and diverse factors related to impairment of maxillary growth than the bilateral cleft type; (2) the identical surgical technique by a single surgeon to reduce surgery-related bias; and (3) similar age to reduce growth-related bias. Although it is possible that differences in growth patterns can be seen among cleft types, few studies have compared the effects of cleft type on initial growth patterns of patients with cleft.…”

Comparison of the effects of maxillary protraction using facemask and miniplate anchorage between unilateral and bilateral cleft lip and palate patients

“…[1][2][3][4][5][6] In addition, cleft patients are known to have an increased vertical growth pattern compared to that of noncleft patients 1,[7][8][9][10][11][12][13] and to maintain their initial vertical pattern during growth. 14 Facemask therapy for maxillary protraction has been regarded as an effective tool for producing orthopedic change in cleft patients. 15,16 Traditionally, several intraoral devices such as the labiolingual arch, quadhelix, and rapid maxillary expansion (RME) appliance have been used as tooth-borne anchorage for facemask.…”