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Timing of palate repair affecting growth in complete unilateral cleft lip and palate
1Department of Cleft Lip and Palate Surgery, West China College of Stomatology, Sichuan University, Chengdu, China.
Insights
Delayed palate repair in patients with complete unilateral cleft lip and palate (UCCLPs) using the von Langenbeck technique between 4-12 years improved facial morphology. Later repair resulted in a more protrusive maxilla and less mandibular rotation compared to early repair before 4 years.
Area of Science:
- Craniofacial surgery
- Orthodontics
- Pediatric dentistry
Background:
- Complete unilateral cleft lip and palate (UCCLPs) significantly impacts facial development.
- The timing of palate repair is a critical factor influencing craniofacial outcomes.
- Understanding the long-term effects of surgical timing is essential for optimizing treatment protocols.
Purpose of the Study:
- To evaluate the influence of different cleft palate repair timings on facial morphology in patients with UCCLPs.
- To compare cephalometric measurements of UCCLP patients based on the age of palate repair.
- To determine the optimal timing for von Langenbeck palatoplasty to achieve favorable facial aesthetics.
Main Methods:
- A retrospective study involving 46 nonsyndromic UCCLP patients and 38 controls.
- Cephalometric analysis using 35 standardized measurements to assess facial morphology.
- Statistical comparisons included Student's t-test, one-way ANOVA, and rank sum tests with a 95% significance level.
Main Results:
- Palatoplasty between 7-12 years showed increased PMP-A, PMP-ANS, Ba-ANS, Ba-A, and Ba-N-ANS compared to repair before 4 years.
- UCCLPs repaired between 4-12 years exhibited a smaller Y-axis angle than those repaired before 4 years.
- Maxillary sagittal length increased with delayed von Langenbeck repair.
Conclusions:
- Delayed von Langenbeck palate repair (4-12 years) in UCCLPs leads to a more protrusive maxilla and less clockwise mandibular rotation.
- Optimal facial morphology was observed in UCCLPs undergoing palate repair between 4-12 years using the von Langenbeck technique.
- The timing of palate repair significantly influences craniofacial development in UCCLP patients.
Objective:
To evaluate the facial morphology characteristics of patients with complete unilateral cleft lip and palate (UCCLPs) who had undergone cleft palate repair at different times.
Design:
This study included 46 nonsyndromic UCCLPs and 38 age and sex matched non-cleft patients. 35 cephalometric measurements were used to evaluate the facial morphology. Student's t-test, one-way ANOVA and rank sum tests were used for comparison. Significant difference was defined at 95% level.
Results:
The data showed that UCCLPs who had palatoplasty between 7 and 12 years had greater PMP-A, PMP-ANS, Ba-ANS, Ba-A, Ba-N-ANS than those operated on before 4 years of age, and UCCLPs who had palatoplasty at 4-12 years had smaller Y-axis angle than those operated on before 4 years of age.
Conclusions:
The maxillary sagittal length increased gradually as von Langenbeck repair was delayed. UCCLPs who underwent palate repair using von Langenbeck technique at 4-12 years had a more protrusive maxilla and less clockwise rotated mandible than those repaired before 4 years. UCCLPs operated using the von Langenbeck technique at 4-12 years had better head-face morphology than those operated on before 4 years. There was no difference in facial morphology among UCCLPs with palate repair at 4-12 years.
