Dental Arch Relationships following Palatoplasty for Cleft Lip and Palate Repair

Abstract

Palatal scarring is assumed to be a primary cause of facial growth derangement in cleft lip and palate. Evidence supporting this hypothesis is confounded by the clinical involvement of various surgeons, and therefore definitive conclusions are not possible. In this study, we investigated the dental arch relationship in two groups, Exposed (47 children; 11.2 yrs) and Unexposed (61 children; 11.2 yrs), with a unilateral cleft lip and palate operated on by the same surgeon. The technique of hard palate repair differed between the two groups. In the Exposed group, palatal bone of the non-cleft side only was left denuded, inducing scar formation. In the Unexposed group, a vomerplasty with tight closure of the soft tissues was applied. Three raters graded the dental arch relationship and palatal morphology using the EUROCRAN Index. The dental arch relationship in the Exposed group was less favorable than in the Unexposed group (p = 0.009). Palatal morphology in both groups was comparable (p = 0.323). This study demonstrates that reduction of denuded bony areas on the palate after palatal repair with a vomer flap had a favorable effect on the dental arch relationship. For palatal morphology, no effect of the type of palatal repair was found.

Which index should be used to measure primary surgical outcome for unilateral cleft lip and palate patients?

“…The EUROCRAN palatal component scores were the lowest of all the indices tested in this study, with the interexaminer 5 year age group scores being particularly low at 0.51 and 0.553 (Table 2). This is similar to the findings of previous workers (17,18). Palatal morphology is also an added complexity to the index.…”

“…It is important to first note what is considered as acceptable reliability in the wider literature. Published weighted Kappa scores have a wide range from 0.56 to 1.00 (7, [13][14][15][16][17]. Ideally, in large multi-centre studies intra-examiner weighted Kappa scores should be >0.8 and inter-examiner >0.7 to ensure results are reliable.…”

Three-dimensional evaluation of surgical techniques in neonates with orofacial cleft

“…[141516] Individuals with cleft lip and palate who were not submitted to primary surgeries have the maxilla with normal growth potential in relation to the sagittal dimension. [171819] That is, primary surgeries cause inhibitory effects on transversal or anterior-posterior development of the dental arches, depending on either the surgery type performed or the rehabilitative protocol chosen.…”

Use of hyperdry amniotic membrane in operations for cleft palate: a study in rats

“…1,2 To resolve the problem there has been considerable discussion on the most suitable technique or material with which to repair the palate. [2][3][4] Bovine and porcinederived collagenous materials act as chemoattractants for wound healing, and are commonly placed on surgical wounds in the oral cavity and used to cover the raw surface that remains after repair of a cleft palate. 3,5 The biocompatibility and availability of these materials have been well studied, but there is always the possibility that these xenogeneic materials may be a source of undetected zoonotic pathogens.…”