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Palate dimensions in six-year-old children with unilateral cleft lip and palate: a six-center study on dental casts
Vesna Koželj1, Miljana Vegnuti, Martina Drevenšek
1Department of Maxillofacial and Oral Surgery, Zaloska c 2, SI -1525 Ljubljana, Slovenia. vesna.kozelj@mf.uni-lj.si
Insights
Children with unilateral cleft lip and palate (UCLP) undergoing stepwise repair and later hard palate closure show improved palatal dimensions. This contrasts with earlier, one-stage repair methods, indicating better outcomes for noncleft-like palatal development.
Area of Science:
- Craniofacial surgery
- Pediatric dentistry
- Plastic surgery
- Genetics and developmental biology
Background:
- Unilateral cleft lip and palate (UCLP) significantly impacts craniofacial development, particularly palatal dimensions.
- Surgical timing and techniques for UCLP repair are critical factors influencing long-term outcomes.
- Understanding the morphologic characteristics of the palate in treated UCLP patients is essential for optimizing treatment protocols.
Purpose of the Study:
- To compare palatal dimensions in 6-year-old children with UCLP treated by different surgical protocols.
- To compare palatal dimensions in UCLP patients with those of noncleft children.
- To identify treatment-related factors influencing palatal morphology in UCLP.
Main Methods:
- Retrospective intercenter outcome study involving 129 children with repaired UCLP and 30 controls.
- Analysis of upper dental casts using the trigonometric method to assess sagittal, transverse, and vertical palatal dimensions.
- Statistical analysis included descriptive methods, nonparametric tests, hierarchical clustering, k-means clustering, and principal component analyses.
Main Results:
- Significant differences in palatal dimensions were observed between all five UCLP groups and the control group (p < .05).
- One-stage cleft repair resulted in significantly different palatal dimensions compared to other cleft repair groups (p < .05).
- Principal component analysis identified three distinct palatal morphologic clusters; noncleft children uniformly fell into one cluster, while treated children were distributed across all three, with distribution correlating with age at palatal closure and number of primary surgeries.
Conclusions:
- Stepwise repair with hard palate closure after age two yields palatal dimensions closer to noncleft controls at age six.
- Earlier palatal closure and one-stage cleft repair are associated with less favorable palatal dimensions.
- Treatment protocols significantly influence the morphologic characteristics of the palate in children with UCLP.
Objective:
To compare palatal dimensions in 6-year-old children with unilateral cleft lip and palate (UCLP) treated by different protocols with those of noncleft children.
Design:
Retrospective intercenter outcome study. Patients : Upper dental casts from 129 children with repaired UCLP and 30 controls were analyzed by the trigonometric method.
Setting:
Six European cleft centers. Main outcome measures : Sagittal, transverse, and vertical dimensions of the palate were observed.
Statistics:
Palate variables were analyzed with descriptive methods and nonparametric tests. Regarding several various characteristics measured on a relatively small number of subjects, hierarchical, k-means clustering, and principal component analyses were used.
Results:
Mean values of the observed dimensions for five cleft groups differed significantly from the control (p < .05). The group with one-stage closure of the cleft differed significantly from all other cleft groups in most variables (p < .05). Principal component analysis of all 159 cases identified three clusters with specific morphologic characteristics of the palate. A similar number of treated children were classified into each cluster, while all children without clefts were classified in the same cluster. The percentage of treated children from a particular group that fit this cluster ranged from 0% to 70% and increased with age at palatal closure and number of primary surgical procedures.
Conclusion:
At 6 years of age, children with stepwise repair and hard palate closure after the age of two more frequently result in palatal dimensions of noncleft control than children with earlier palatal closure and one-stage cleft repair.
