Effects of Multiple Factors on Treatment Outcome in the Three-Dimensional Maxillary Arch Morphometry of Children With Unilateral Cleft Lip and Palate

Abstract

Studies have claimed that the maxillary arch dimension of unilateral cleft lip and palate (UCLP) patient is significantly smaller than normal patient. Multiple factors (both congenital and post natal treatment factors) are believed to have an impact on the treatment outcome (maxillary arch retardation) of UCLP patient. The aim of this study was to evaluate the effects of multiple factors on the treatment outcome by assessing the maxillary arch dimension of UCLP Children. Eighty-five Malaysian UCLP children were taken who received cheiloplasty and palatoplasty. Laser scanned 3D digital models of UCLP subjects were prepared before any orthodontic treatment and bone grafting at 7.69 ± 2.46 (mean± SD) years of age. Intercanine width (ICW), intermolar width (IMW), and arch depth (AD) measurements of maxillary arch were measured with Mimics software. Multiple linear regression analyses were used to evaluate the association between multiple factors (gender, UCLP type, UCLP side, family history of cleft, family history of class III malocclusion, techniques of cheiloplasty, and techniques of palatoplasty) and maxillary arch dimensions (ICW, IMW, and AD). P value was set at 5%. Significant association was found between 2 techniques of cheiloplasty and ICW (P = 0.001) and also between 2 techniques of palatoplasty and ICW (P = 0.046) of maxilla. No significant association observed in IMW and AD in relation to all other factors. Modified Millard techniques of Cheiloplasty and Bardach technique of palatoplasty had unfavorable effect on the treatment outcome by assessing the maxillary arch dimension (ICW) using laser scanned 3D digital models in Malaysian UCLP children.

Sagittal Jaw Relationship of Different Types of Cleft and Non-cleft Individuals

“…Poor maxillary growth of CLP patients is one of the chief apprehensions of orthodontists for the corrections of the dento-facial discrepancies especially during the period of early adolescence ( 7 ). The outcome of the current study may help and support the surgeon to bring out the proper primary surgical techniques and also to the orthodontist to make better treatment plans for CLP patients.…”

“…The outcome of the current study may help and support the surgeon to bring out the proper primary surgical techniques and also to the orthodontist to make better treatment plans for CLP patients. The patient who exhibited smaller SNA, ANB and Wits appraisal specifies the poor maxillary growth may perhaps have need of orthognathic surgery in future for the complete correction of dento-facial divergences ( 7 , 23 ). Wits appraisal is a supreme linear cephalometric parameter which is used to evaluate and assist an additional information with ANB angle for the assessment of skeletal base discrepancies ( 24 ).…”

“…A linear cephalometric analytic obtained by projecting straight lines from the A and B points, respectively, unto the functional occlusal plane at 90 • and measuring the horizontal distance form point AO to BO direction of the jaw utterly influenced by the earlier treatment protocol such as time and techniques of primary surgeries (7)(8)(9)(10)(11)(12). The detrimental effect of palatoplasty on sagittal growth of maxilla has been widely documented in literature (9) but whether cheiloplasty impedes the growth is still in controversy (8,13).…”

“…The detrimental effect of palatoplasty on sagittal growth of maxilla has been widely documented in literature (9) but whether cheiloplasty impedes the growth is still in controversy (8,13). A number of researchers found that cheiloplasty has an effect on maxillary incisors, alveolar bone and development of maxilla as well whether some researchers claimed no effect on maxillary development (7,11,12,14,15). The craniofacial characteristics of CLP can be assessed from cephalogram (16) and cone-beam computed tomography (17) as well.…”

“…Atypical sagittal growth of maxilla is a common manifestation in patients with UCLP; acknowledged by many researchers yet all of them came to an understanding that the growth and direction of the jaw utterly influenced by the earlier treatment protocol such as time and techniques of primary surgeries ( 7 – 12 ). The detrimental effect of palatoplasty on sagittal growth of maxilla has been widely documented in literature ( 9 ) but whether cheiloplasty impedes the growth is still in controversy ( 8 , 13 ).…”