Craniofacial development in cleft lip and palate children related to different treatment regimes

Outcome of treatment in 85 children with unilateral cleft, lip, alveolus, and palate who had been treated according to four regimes was studied using lateral skull radiographs, extra oral photographs, intra oral radiographs and orthopantographs. The treatment regimes differed with regard to: the inclusion of presurgical orthopaedics in one group, the type of lip closure, the type and timing of palatal closure, and timing of bone grafting to the alveolus. A method of pooling subgroups and comparing lateral skull radiographs from different centres was developed to obtain more meaningful comparisons between centres. The maxillary, mandibular, and vertical hard tissue development as well as the soft tissue profile were studied using lateral skull radiographs. The appearance of the extraoral soft tissue was assessed by a panel using photographs. The tooth status and the success of transplants in the cleft area were evaluated using intra oral radiographs and orthopantographs. Treatment regimes that did not include bone grafting seemed to be most favourable for maxillary and mandibular development. Treatment regimes without bone-grafting and those that included bone grafting at 10 years of age seemed to be most favourable for the vertical skeletal proportions. The soft tissue profile was developed best after regimes that included bone grafting at 10 years of age. Facial appearance was equally good in the group that received bone grafts at 6 months after presurgical orthopaedics and in the group that received bone grafts at 10 years of age. Tooth status and the percentage of successful transplants were best in the group that received bone grafts after the eruption of the incisors but before the eruption of the canines.