Influence of Early Hard Palate Closure in Unilateral and Bilateral Cleft Lip and Palate on Maxillary Transverse Growth during the First Four Years of Age

Abstract

Objective To evaluate and compare the effects of early primary closure of the hard palate on the anterior and posterior width of the maxillary arch in children with bilateral (BCLP) and unilateral (UCLP) cleft lip and palate during the first 4 years of life. Design A retrospective, mixed-longitudinal study. Setting Cleft Palate Center of the University of Erlangen-Nuremberg. Subjects and Methods The present investigation analyzes longitudinally 42 children with UCLP and 8 children with BCLP between 1996 and 2000 with early simultaneous primary closure of lip and hard palate (4 to 5 months). Palatal arch width was measured on dental casts with a computer-controlled three-dimensional digitizing system, and their growth velocities were calculated from consecutive periods (mean follow-up 39 months). Differences in growth velocities were compared with those of 25 children with UCLP and 15 children with BCLP with delayed closure of hard palate (12 to 14 months). Results and Conclusions There was no significant difference in terms of anterior and posterior maxillary width between early and delayed closure of hard palate within the first 4 years of life.

Influence of pharyngeal flap surgery on maxillary outgrowth in cleft patients

“…9,24,25 Nevertheless, the authors are aware of recent reports that state that acceptable maxillary antero-posterior growth is accomplished in both single and two stage palate repair. 28,29 A factor of major influence seems to be the involvement of the hard palate, since the frequency of PFS is 38.5% in CCP (10 of 26) against 29.2% in ICP (7 of 24) patients, this result is in accordance with the reports of De Buys Roessingh and Vedung. 23,26 A possible explanation could be the attachment of the vomer, since a report by Bicknell et al revealed that clefts with an unattached vomer are far more likely to require a PFS.…”

The efficacy of vomer flap for closure of hard palate during primary lip repair

“…Most of the reported cases on the use of vomer with favourable growth outcomes are from the developed world, where presurgical orthopaedics is extensively practised. 20,26 Furthermore, in most of the studies, both the lip and palate surgeries were done before 1 year of age. In most cleft centres catering to the developing world, there are very few cases that report at an early age for cleft-palate repair.…”

Facial and Nasolabial Aesthetics of Complete UCLP Submitted to 2-Stage Palate Repair With Vomer Flap

“…At the same surgery, nasal alar repositioning was performed by the Skoog technique. Anterior hard palate repair used a single layer of vomer flap that was folded laterally and inserted into the lower segment (Semb, 1991; Lehner et al, 2003). In a second surgical time at 18 months of age, the closure of the soft palate together with the posterior region of hard palate was performed using Von Langenbeck technique (Semb, 1991).…”