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Growth sites and growth mechanisms at risk in cleft lip and palate
1Department of Orthodontics, Faculty of Odontology, Göteborg University, Sweden.
Insights
Facial cleft surgery can impact midfacial growth, particularly due to scar tissue from palatal repair. Minimizing scar tissue and protecting the vomero-(pre)maxillary suture are key to preserving normal maxillary development in cleft patients.
Area of Science:
- Craniofacial biology
- Pediatric surgery
- Orthodontics
Background:
- Facial clefts disrupt normal craniofacial development, affecting the nose, lip, and jaw.
- Surgical interventions aim to correct these deformities but can inadvertently impede midfacial growth.
- Understanding growth mechanisms is crucial for optimizing treatment outcomes.
Purpose of the Study:
- To review aspects of midfacial growth in normal and cleft subjects.
- To elucidate the impact of surgical interventions on maxillary development.
- To discuss strategies for mitigating negative growth effects.
Main Methods:
- Review of literature on craniofacial growth and cleft repair.
- Analysis of growth influences on the maxilla and dentoalveolar structures.
- Discussion of scar tissue effects and potential preventative measures.
Main Results:
- Lip surgery generally does not affect maxillary elongation, but palatal repair scar tissue can impede growth.
- Scar tissue from palatal repair can negatively affect periosteal growth and dentoalveolar development.
- Vomero-(pre)maxillary suture integrity is vital for normal midfacial growth and should be preserved during early surgery.
Conclusions:
- Palatal scar tissue is a significant factor limiting midfacial growth post-cleft surgery.
- Surgical techniques should aim to minimize scar formation and protect critical growth sutures.
- Further research into scar reduction methods could improve long-term functional and aesthetic results in cleft patients.
Abstract:
A newborn with some kind of facial cleft displays certain characteristics of the nose, upper lip, and jaw caused by abnormal influence on specific growth sites and growth mechanisms. Treatment, particularly surgery, attempts to counteract this aberrant development, for both functional and aesthetic reasons. However, not infrequently, therapy impedes future midfacial growth to a greater or lesser degree. To better understand the varying growth influence, this article aims to review certain aspects of growth of the middle third of the face in both normal and cleft subjects. The normal elongation of the maxilla, to give space for the molars, is usually not affected by lip surgery but rather by scar tissue from palatal repair. The displacement of the upper jaw in relation to the vomer is recognized. Early surgery should therefore avoid affecting the growth of the vomero-(pre)maxillary suture if possible. Periosteal growth, necessary for the development of dentoalveolar structures, might be affected by scar tissue from palatal repair. Different ways to reduce the development of palatal scars and their negative effects on growth are discussed.
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