Preoperative Cleft Lip Measurements and Maxillary Growth in Patients With Unilateral Cleft Lip and Palate

Abstract

Objective : Maxillary growth in patients with cleft lip and palate is highly variable. The authors' aim was to investigate associations between preoperative cleft lip measurements and maxillary growth determined cephalometrically in patients with complete unilateral cleft lip and palate (cUCLP). Design : Retrospective cross-sectional study. Patients : Children with cUCLP. Methods : Preoperative cleft lip measurements were made at the time of primary cheiloplasty and available for each patient. Maxillary growth was evaluated on lateral cephalometric radiographs taken prior to any orthodontic treatment and alveolar bone grafting (8.5 ± 0.7 years). The presence of associations between preoperative cleft lip measurements and cephalometric measures of maxillary growth was determined using regression analyses. Results : In the 58 patients included in the study, the cleft lateral lip element was deficient in height in 90% and in transverse width in 81% of patients. There was an inverse correlation between cleft lateral lip height and transverse width with a β coefficient of -0.382 (P = .003). Patients with a more deficient cleft lateral lip height displayed a shorter maxillary length (β coefficient = 0.336; P = .010), a less protruded maxilla (β coefficient = .334; P = .008), and a shorter anterior maxillary height (β coefficient = 0.306; P = .020) than those with a less deficient cleft lateral lip height. Conclusions : Patients with cUCLP present with varying degrees of lateral lip hypoplasia. Preoperative measures of lateral lip deficiency are related to later observed deficiencies of maxillary length, protrusion, and heights

Orthodontic burden of care for patients with a cleft lip and/or palate

“…Children born with cleft lip and/or palate are more likely to experience a range of dental anomalies and skeletal issues when compared with non-cleft counterparts (Antonarakis et al, 2016; Lai et al, 2008). Therefore, they often require complex long-term orthodontic treatment, often in combination with maxillofacial surgery, in order to produce a good facial appearance, with an aesthetic, functional and stable occlusion.…”

“…This condition may lead to a variety of dental issues, with studies showing that 94% of cleft patients are found to have at least one dental anomaly (Nicholls, 2016). In addition, the form and shape of the maxillary arch may also be affected: vertical, antero-posterior and transverse growth is often reduced with potential subsequent adverse alteration of the dental archform (Antonarakis et al, 2016). The resulting effects on the dental occlusion of these patients can make them more challenging to manage orthodontically.…”

Objective Assessment of the Unilateral Cleft Lip Nasal Deformity Using Three-Dimensional Stereophotogrammetry: Severity and Outcome

“…While such a measure of lip deficiency may not intuitively make sense when evaluating nose deformity, deficiencies of the lateral lip have been associated with hypoplasia. Measured deficiencies of lateral lip have been associated with dental agenesis 23,24 , dental arch deficiencies 25 , and maxillary hypoplasia 24 . The lateral lip ratio may therefore be a surrogate objective measure of cleft related hypoplasia when assessing cleft severity and the associated nasal deformity.…”

Do Infant Cleft Dimensions Have an Influence on Occlusal Relations? A Subgroup Analysis Within an RCT of Primary Surgery in Patients With Unilateral Cleft Lip and Palate

“…Several studies, investigating the association between cleft size at birth and cephalometric measurements before orthodontics showed a significantly negative correlation between dimensions of the defect and maxillary length and protrusion (Liao et al, 2010; Chiu et al, 2011; Antonarakis et al, 2016). Patients with large clefts and small arch circumference or arch length have been shown to have a less favorable maxillary protrusion at age of 5 years (Peltomaki et al, 2001).…”