Craniofacial Growth at Age 6–11 Years after One-Stage Cleft Lip and Palate Repair: A Retrospective Comparative Study with Historical Controls

Abstract

Background: Primary alveolar bone grafting inhibits craniofacial growth. However, its effect on craniofacial growth in one-stage cleft lip and palate protocols is unknown. This study investigated whether primary alveolar bone grafting performed during one-stage unilateral cleft lip and palate repair negatively affects growth up to 6–11 years old. Methods: The craniofacial growth, dental arch relationship and palatal morphology at 6–11 years old in children with unilateral cleft lip and palate were compared retrospectively. Two cohorts after a one-stage protocol without (Group A) and with (Group B) primary bone grafting at the same center were compared. Further, cephalometric measurements for growth were compared with an external cohort of a one-stage protocol and a heathy control. Results: Group A comprised 16 patients assessed at 6.8 years (SD 0.83), and Group B comprised 15 patients assessed at 9 years (SD 2.0). Cephalometric measurements indicated similar sagittal maxillary growth deficits and a significant deviation in maxillary inclination in both groups compared to the healthy group. Moderate to severe changes in palatal morphology were observed in 70% of the members in both groups. Conclusion: Omitting primary alveolar bone grafting under the one-stage protocol with two-flap palatoplasty studied did not improve growth at 6–11 years. The results implicate two-flap palatoplasty with secondary healing as having greater adverse effects on growth than primary alveolar bone grafting. Dental and palatal morphology was considerably compromised regardless of primary alveolar bone grafting.

A Cross-Sectional Study of the Dental Arch Relationship and Palatal Morphology after Cleft Surgery in Italian Children with Unilateral Cleft and Lip Palate

“…We obtained percentages of favourable DARs and PMs similar to those reported in the Swiss and Polish studies [ 14 , 20 , 25 ] using an EPR protocol but better than those achieved by Haque et al with delayed surgical protocols [ 18 ]. Different surgical timings and the surgical techniques used could account for these discrepancies.…”

“…To our knowledge, only five studies had evaluated the effect of surgical treatment on maxillary growth using this index [ 14 , 17 , 18 , 20 , 25 ]. Fudalej et al [ 20 ] compared DAR and PM in preadolescent Polish children with UCLP treated with a one-stage surgical protocol differing only in the palatoplasty technique employed.…”

“…Yew et al [ 17 ] did not find any statistically significant association between different cheiloplasty and palatoplasty techniques and the DAR in Malay children with UCLP. Finally, Benitez et al [ 25 ] reported that the DAR and PM were considerably compromised following one-stage UCLP repair in Swiss children, regardless of primary alveolar bone grafting.…”

“…The sample size was calculated based on the percentage of successful DARs reported in Western European UCLP children [ 25 ], with a precision of 10% and a level of significance of 5%. The minimum number of children to enrol into this study was 60.…”

The morphological peculiarities of the maxillo-facial region in children with cleft lips and palate

“…Pentru a limita inhibarea creșterii prin intervenții chirurgicale, s-au elaborat mai multe protocoale ce prevăd etapizarea chirurgicalăal despicăturilor labio-maxilo-palatine cu un impact mai mic asupra dezvoltării și creșterii cranio-faciale [7]. Protocoalele chirurgicale elaborate într-o etapă au unele dezavantaje care se concentrează asupra reducerii suferinței atît pacientului cît și părinților, timpul de anestezie de scurtă durată și scăderea costurilor generale de asistență medicală [8]. Diferențele tehnice între protocoalele cu o singură etapăar putea avea o influență asupra creșterii cranio-faciale și, prin urmare, ar trebui investigate.…”