Growth in children with clefts: serial hand-wrist x-ray evidence
Insights
Children with cleft palate exhibit varied skeletal maturation patterns, influenced by sex and cleft type. These findings suggest distinct etiological factors for different cleft conditions, highlighting the importance of sex and diagnosis in research.
Area of Science:
- Pediatric endocrinology
- Craniofacial anomalies
- Skeletal maturation
Background:
- Children with clefts sometimes present with growth delays and delayed maturation.
- Hand-wrist radiography is used to assess skeletal age via the Tanner-Whitehouse 2 method.
Purpose of the Study:
- To compare skeletal ages of children with various cleft types (cleft palate, unilateral cleft lip and palate, bilateral cleft lip and palate).
- To investigate if growth delay explains the smaller body size and delayed maturation observed in children with clefts.
Main Methods:
- Retrospective analysis of serial hand-wrist x-rays from 1950-1968.
- Skeletal age assessed using Tanner-Whitehouse 2 standards.
- Evaluator was blinded to patient age, sex, and diagnosis.
Main Results:
- Boys and girls with cleft palate showed different skeletal maturation patterns.
- Boys with unilateral cleft lip and palate and bilateral cleft lip and palate exhibited distinct maturational patterns.
- Girls with unilateral cleft lip and palate often had advanced skeletal ages, unlike boys.
Conclusions:
- Sex influences maturational patterns in children with cleft palate.
- Different cleft types (unilateral vs. bilateral cleft lip and palate) suggest varying etiological factors.
- Separate analysis by sex and diagnostic category is crucial for etiological research in cleft conditions.
Objective:
Serial hand-wrist x-rays were assessed for Tanner-Whitehouse 2 skeletal ages of children with cleft palate, unilateral cleft lip and palate, and bilateral cleft lip and palate. The skeletal ages were compared by cleft type to see whether growth delay might explain the small body size for age and delayed maturation sometimes seen elsewhere in children with clefts.
Design:
This is a retrospective study of serial x-rays collected between 1950 and 1968 at the Philadelphia Growth Center. The author was blind to age, sex, and diagnosis while reading these films.
Participants:
These x-rays were taken as part of routine auxological evaluation of the normality of growth status.
Main Outcome Measures:
Distributions of skeletal age patterns in advance of or delayed from chronological age and frequencies of clinically significant deviant patterns are presented.
Conclusions:
Boys and girls with cleft palate show different maturational patterns, supporting a sex influence on the etiologies of at least some of these anomalies. Boys with unilateral cleft lip and palate and bilateral cleft lip and palate have different maturational patterns, consistent with these anomalies having different sets of etiological factors. Girls with unilateral cleft lip and palate almost always have advanced skeletal ages; whereas, boys sometimes do not. These results support the need for keeping both sex and diagnostic categories separate when conducting etiological searches.
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