Craniofacial Cephalometric Morphology and Later Need for Orthognathic Surgery in 6-Year-Old Children with Bilateral Cleft Lip and Palate

Abstract

Six-year-old children with bilateral cleft lip and palate (BCLP) were examined to evaluate the need for orthognathic surgery later in life and to cephalometrically compare the craniofacial morphology of those needing orthognathic surgery with those not needing surgery. Design Retrospective longitudinal study. Patients Thirty-eight consecutive nonsyndromic patients with BCLP (29 boys). Main Outcome Measures Children with BCLP were analyzed from lateral cephalograms taken at a mean age of 6.1 years (range 5.8 to 6.6 years). The need for orthognathic surgery in these patients was determined from hospital records at the mean age of 18.2 years (range 15.5 to 20.2 years). Student's t test and chi-square test were used in statistical analysis. Results The overall frequency of maxillary or bimaxillary osteotomy was 66% (25 of 38). The patients needing maxillary or bimaxillary osteotomies had flatter soft tissue profiles (n-sn-gn), shorter lower facial heights (ANS-ME), and smaller mean values of the ANB angle (sagittal maxillomandibular relationship) at the age of 6 years than those who did not. ANB angle was the most significant predictor for later osteotomy. Despite individual variation, all children (n = 13) whose ANB angle was less than 7°, needed later orthognathic surgery; whereas, none of those whose ANB angle was greater than 12.5° (n = 6) needed maxillary osteotomies. Conclusions Two thirds of children with BCLP needed orthognathic surgery later in life. Half of the children who needed later osteotomies could be identified at the age of 6 years by having an ANB angle less than 7°.

Blepharocheilodontic (BCD) syndrome: New insights on craniofacial and dental features

“…Identifying these patients early in life is important as it can help tailor their treatment so that treatment efficacy is maximized and patient and family suffering reduced. “At risk” patients can be identified early, even at the age of 6 years, as having an ANB angle of less than 7° [Heliövaara et al, ]. At the age of 8 years our group of BCD syndrome patients had a mean ANB angle of 0.7°, indicating a great need for prolonged and lengthy treatment.…”

Comparative Study of Early Secondary Nasal Revisions and Costs in Patients With Clefts Treated With and Without Nasoalveolar Molding

“…The revision rate in non-NAM treated patients in our study was, however, not significantly different from the revision rate reported in other studies. [24][25][26][27][28][29][30][31][32][33][34][35][36] In addition, analyses were limited by a small sample size in non-NAM group, especially among patients with BCLP. To account for this fact, we provided analyses using meta-analytic averages, which show even stronger support for a lowered risk of revision among NAM-prepared patients.…”

Age-Related Changes Between the Level of Velopharyngeal Closure and the Cervical Spine

“…The success of speech outcomes corresponds to the patient's preoperative craniofacial morphology. 12,13 Preoperative morphology has primarily been assessed in the orthognathic and dental literature and focused on anterior craniofacial structures. 13 Craniofacial soft tissue structures and their functions have further been a focus of recent studies 14-18 .…”

“…12,13 Preoperative morphology has primarily been assessed in the orthognathic and dental literature and focused on anterior craniofacial structures. 13 Craniofacial soft tissue structures and their functions have further been a focus of recent studies 14-18 . Specifics of the craniofacial structures and the upper cervical spine along with changes across the age span as they relate to surgical outcomes warrant further analysis.…”