Congenital and Postnatal Factors Inducing Malocclusions in Japanese Unilateral Cleft Lip and Palate Patients—Determination Using Logistic Regression Analysis

Abstract

Objective : To assess the congenital and postnatal factors that affect degree of malocclusion in patients with unilateral cleft lip and palate using multivariate statistical analysis. Design : Retrospective study. Patients : All information on 135 subjects with unilateral cleft lip and palate was obtained from an oral examination and radiograph at the initial examination at an orthodontic clinic and from surgical records. Plaster models were taken before orthodontic treatment. The ages of the subjects ranged from 5 to 8 years with a mean age of 6.9 years. All primary surgeries for the patients were performed at a university hospital. Main Outcome Measures : The GOSLON Yardstick was used to assess the dental arch relationships (degree of malocclusion) in patients. Family history of Class III, degree of cleft, and congenitally missing upper lateral incisor on the cleft side were chosen as congenital factors inducing malocclusion. Presurgical orthopedic treatment, cheiloplasty, and palatoplasty were chosen as postnatal factors. Associations between various factors and dental arch relationships were assessed using logistic regression analysis. Results : According to adjusted odds ratios, family history of Class III is associated with a significantly worse dental arch relationship. Palatoplasty using push-back alone correlated to a dental arch relationship that was significantly worse than palatoplasty using push-back with a buccal flap. Conclusions : Multivariate analysis shows evidence that a positive family history of Class III and palatoplasty using push-back alone are associated with worse malocclusion of unilateral cleft lip and palate patients.

The effect of various factors on the dental arch relationship in non-syndromic unilateral cleft lip and palate children assessed by new approach: a retrospective study

“…In our study, we evaluated the Millard and modified Millard techniques for cheiloplasty and our results showed unfavorable outcome with the modified Millard technique for cheiloplasty. Others authors [16, 20, 21, 29] have also found significant differences. Kajii et al [20] and Alam et al [21] evaluated Japanese patients with UCLP and found that the modified Millard technique with vomer flap had a poor effect on DAR; this study used a different index.…”

“…Others authors [16, 20, 21, 29] have also found significant differences. Kajii et al [20] and Alam et al [21] evaluated Japanese patients with UCLP and found that the modified Millard technique with vomer flap had a poor effect on DAR; this study used a different index. However, in another study, the Millard technique showed tremendous results with narrow clefts, whereas the Tennison technique showed more flexibility with wide clefts [29].…”

“…However, most studies worldwide have evaluated treatment outcomes based on individual factors [7, 16–19]. A very small number of studies has considered various factors together to determine which factor affects the DAR in UCLP children [20, 21]. …”

Is outcome based cleft research leading somewhere?

“…Extensive research efforts have predicted the treatment outcomes of unilateral cleft lip and palate cases based on the specific indices available. [4][5][6][7][8][9][10] We recommend the development of an index which incorporates all growth planes as well as focuses on the cephalometric landmarks. It would enable surgeons to predict the outcome of all types of clefts and plan interventions accordingly.…”

Spectrum of cheiloplasty has detrimental effect on maxillary growth: myth or fact?

“…They used the 5-year-old index and Goslon Yardstick for the evaluation of dental arch relationship and suggested that Modified Millard cheiloplasty is more favorable than vomer flap. Kajii et al (2013) [3] , analyzed subjects with unilateral cleft lip and palate (UCLP). The Goslon Yardstick was used to assess the dental arch relationship.…”