Extent of maxillary deficiency in patients with complete UCLP and BCLP

Primary surgery in patients with complete unilateral and bilateral cleft lip and palate restricts transverse and sagittal maxillary growth. Additional surgical maxillary advancement might become necessary after completion of growth. The aim of this study was to determine the extent of maxillary deficiency at an early stage during the transitory dentition, and to identify factors that might indicate the need for a later maxillary advancement.

Lateral head films and casts of 40 non-syndromatic patients with complete UCLP (n=29) and BCLP (n=11) were evaluated. This retrospective evaluation included measurements of casts and lateral head films from all patients at the beginning of orthodontic treatment during the transitory dentition (T1), after completion of orthodontic treatment (T2) and after completion of growth (T3). The statistic analysis comprised t-tests (Anova) and correlation analyses (Pearson).

SNA decreased significantly between T1 and T2. At T3, 27.5% of the patients showed a sagittal maxillary deficiency with need for osteotomy. There were no statistical differences between patients with UCLP and BCLP. Significant positive correlations occurred between SNA and WITS-appraisal (+0.62), and significant negative correlations between SNA and NL/NS (-0.66).

During craniofacial growth patients with complete UCLP and BCLP experience sagittal growth inhibition of the maxilla after primary surgery. A later need for maxillary advancement after completion of growth occurs equally in both cleft types. There are no correlations regarding the need for osteotomy with gender or number of primary surgical measures. It is impossible to predict a need for later maxillary osteotomy during the transitory dentition.

Patients with clefts typically receive long-term treatment. The present results provide useful information for treatment planning and implementation.