Palatal and Alveolar Tissue Deficiency in Infants With Complete Unilateral Cleft Lip and Palate

Abstract

Objective: To investigate intrinsic palatal and alveolar tissue deficiency in patients with unilateral cleft lip and palate (UCLP) as compared to age-matched individuals without UCLP using surface area measurements on 3D scans of plaster casts. Methods: 22 maxillary casts of infants with UCLP from the Wyss Department of Plastic Surgery of NYU Langone Medical Center and 37 maxillary casts from infants without clefts from Sillman's longitudinal study were scanned by Ortho Insight 3D by Motion View Software, LLC (Chattanooga, TN) and measured using Checkpoint software (Stratovan, Davis, CA). The palatal and alveolar surface areas of each cast were measured. The most superior point of the alveolar ridge in front of the incisive papilla and the most superior point of each maxillary tuberosity were connected by a line that ran along the highest part of the alveolar ridge. This line was used to set boundaries for the palatal surface area measurements. The surface areas of greater and lesser segments were measured independently on UCLP casts. A total palatal surface area for the UCLP sample including width of the cleft gap was also measured. Results: There was a statistically significant difference in surface area (P > .001) when we compared the UCLP area of the cleft segments alone with the non-cleft sample. There was a positive correlation (determine the statistical significance) between the surface area of the cleft segments and cleft gap. In addition, there was a statistically significant difference between UCLP plus cleft area and the non-cleft samples in surface area (P < .0001). Conclusion: An intrinsic palatal and alveolar tissue deficiency exists in patients born with UCLP. The amount of tissue deficiency for a patient with UCLP should be considered when developing and executing a patient-specific treatment plan.

Dentoalveolar Arch Dimensions in UCLP Boys After Neonatal Cheiloplasty or After Lip Surgery at the Age of 3 or 6 Months

“…In comparison to the control group, all the measured distances were statistically significantly smaller in all the investigated groups of patients with UCLP. Hypoplasia of the maxilla is well known in patients with UCLP (Schweckendiek, 1978; Capelozza et al, 1993; Nystrom and Ranta, 1994; Bednar et al, 2018).…”

“…Such hypoplasia during the critical period of lip/palate formation has been experimentally shown to cause clefts in animal models (eg, Fraser and Fainstat, 1951; Jelinek and Peterka, 1977). After birth, there is palatal and alveolar tissue deficiency in infants with complete unilateral cleft lip and palate (UCLP) before surgery (Bednar et al, 2018). In adults with untreated (unoperated) UCLP, the maxilla is smaller and more protruded (Capelozza et al, 1993), and its horizontal dimension is reduced (eg, Lambrecht et al, 2000; Meazzini et al, 2011; Delestan et al, 2014).…”

“…Cleft surgery naturally leads to a change in size and shape of the maxillary arch as a result of the increase in tissue tension and scarring at the surgical site (Schweckendieck, 1978). This outcome is not desirable for further growth of the maxilla, which is congenitally hypoplastic (eg, Burian, 1954; Peterka and Mullerova, 1983; Bednar et al, 2018). Due to the progressing ossification of bones and the increase in their rigidity with the increasing age of children, the timing of surgery is another aspect that may influence the impact of the operation on the growth of the maxilla (Schweckendieck, 1978).…”

Avaliação morfométrica 3D dos arcos dentários de crianças com fissura labiopalatina operados por diferentes técnicas cirúrgicas

“…• Distância intercaninos (C-C'): determinada pelos pontos C e C', distância entre os sulcos laterais direito e esquerdo da crista do rebordo alveolar (LIAO et al, 2010;BEDNAR et al, 2018). Na presença de dentes, os pontos para delimitação da área passaram pela margem gengival palatina dos elementos dentários.…”

Análise 3D da área dos arcos dentários em crianças com fissura labiopalatina

“…A utilização de softwares para reconstrução tridimensional possibilita que superfícies irregulares sejam melhor estudadas, com medidas precisas, realizadas automaticamente . O estudo da superfície da área do palato é capaz de descrever melhor a morfologia maxilar, determinar mais claramente a quantidade de tecido palatino e servir como indicação do crescimento maxilar BEDNAR et al, 2018).…”