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Patterns of maxillary alveolar arch growth changes of infants with unilateral cleft lip and palate: preliminary
Bert Braumann1, Ludger Keilig, Angelika Stellzig-Eisenhauer
1Department of Orthodontics, Clinic for Oral and Maxillofacial Surgery, Center for Dentistry, University of Bonn, Bonn, Germany. braumann@uni-bonn.de
Insights
Maxillary growth patterns in infants with incomplete cleft lip and palate differ from those with complete clefts. These distinct growth reactions within the first year suggest varying treatment prognoses for different cleft forms.
Area of Science:
- Craniofacial Surgery
- Pediatric Dentistry
- Orthodontics
Background:
- Significant pathomorphological differences exist at birth between incomplete and complete cleft lip and palate.
- Understanding early maxillary growth patterns is crucial for predicting treatment outcomes.
Purpose of the Study:
- To investigate if reaction patterns in maxillary dimensions can be extracted from changes in different cleft forms within the first year of life.
- To determine if these patterns support a hypothesis of better treatment outcomes for incomplete cleft forms.
Main Methods:
- Utilized 3D laser scanning to digitize and reconstruct maxillary casts from 15 complete unilateral cleft lip and palate (cUCLP) and 13 incomplete unilateral cleft lip and palate (iUCLP) patients.
- Analyzed serial changes in maxillary dimensions and volumes at 1 week, 3, 6, and 12 months of age.
- Patients were treated with passive palatal plates, with cheiloplasty at 6 months and no primary osteoplastic surgery.
Main Results:
- Incomplete cleft lip and palate (iUCLP) patients exhibited decreased sagittal and increased transverse alveolar growth.
- Alveolar crest length increase was 50% less in iUCLP patients compared to cUCLP patients within the first year.
- Molar segment volumes were larger and showed a greater increase over the first year in iUCLP patients.
Conclusions:
- Early maxillary growth patterns vary significantly between incomplete and complete unilateral cleft lip and palate.
- Visible severity of malformation at birth does not allow for definitive conclusions on growth direction and extent.
- Further research is needed to correlate these early growth patterns with long-term treatment outcomes.
Objective:
Because of significant differences in pathomorphology at birth, it may be that a better treatment outcome prognosis exists for patients with incomplete versus complete cleft forms. Can reaction patterns be extracted from changes in maxillary dimensions of different cleft forms within the first year of life to support this hypothesis?
Subjects:
Chronologically consecutive casts of the maxilla (1 week and 3, 6, and 12 months of life) of 15 patients with complete unilateral cleft lip and palate (cUCLP) and 13 patients with incomplete unilateral cleft lip and palate (iUCLP). All patients were treated with passive palatal plates. Cheiloplasty was performed at 6 months of age. No primary osteoplastic surgery was carried out.
Interventions:
Following digitizing with a three-dimensional laser scanner, all cast surfaces were computer reconstructed, aligned, and superimposed. Distances between the surfaces were determined and expressed graphically. Computer-aided determination of defined maxillary dimensions was performed. The volumes of segmented surfaces were determined and compared.
Results:
Within the first year of life, decreased sagittal but increased transverse alveolar growth for patients with iUCLP was found. The increase in alveolar crest length in patients with iUCLP was 50% less within the first year of life than in patients with cUCLP. In the same patients, the volumes of the molar segments were, on average, larger at each registration stage and the increase in these volumes larger within the first year of life.
Conclusion:
Conclusions regarding the direction and extent of growth cannot be drawn from the visible level of severity of the malformation.
