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Advanced or delayed? a retrospective study of skeletal maturation in children with a cleft lip and palate
Xiaoyi Wu1, Wenying Kuang2, Gufeng Liu1
1State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China.
Insights
Children with cleft lip and palate (CLP) experience delayed skeletal maturation but catch up later. Dentition stage is not a reliable indicator of skeletal maturation in these children.
Area of Science:
- Pediatric Dentistry
- Orthodontics
- Craniofacial Development
Background:
- Developmental patterns in children with cleft lip and palate (CLP) impact therapeutic outcomes.
- Uncertainty exists regarding whether CLP development is delayed or advanced.
- Characterizing skeletal maturation and its relation to dentition in CLP is crucial.
Purpose of the Study:
- To characterize developmental patterns in children with CLP using skeletal maturation.
- To explore the relationship between skeletal maturation and dentition in CLP.
- To investigate sex and cleft type differences in developmental trajectories.
Main Methods:
- Retrospective study of 425 children (4-18 years): unilateral cleft lip and palate (UCLP), bilateral cleft lip and palate (BCLP), and non-cleft controls (NCLP).
- Cervical vertebral maturation (CVM) method assessed skeletal maturation; cephalometric radiographs evaluated adenoidal/tonsil hypertrophy.
- Dentition stages (mandibular tooth eruption) and logistic regression analyzed relationships, controlling for hypertrophy and sex.
Main Results:
- Children with CLP showed delayed skeletal maturation compared to NCLP, with a subsequent catch-up growth.
- This delay and catch-up occurred approximately three years earlier in girls than boys with CLP.
- Dentition stages correlated with CVM stages but had limited diagnostic value for skeletal maturation assessment.
Conclusions:
- Children with CLP exhibit a delayed growth spurt onset followed by catch-up growth.
- Dentition stage is unreliable as a surrogate for skeletal maturation in CLP patients.
- Understanding these patterns aids in evaluating developmental potential and optimizing treatment.
Background:
The developmental patterns of children with cleft lip and palate (CLP) can affect the therapeutic effects. However, a consensus has not been reached on whether the development of children with CLP is delayed or advanced. We aimed to characterize the developmental patterns of children with CLP by skeletal maturation and to explore the relationship between skeletal maturation and dentition in children with CLP.
Methods:
This retrospective study included 425 children, aged 4-18 years, categorized into three groups: unilateral cleft lip and palate (UCLP, 157), bilateral cleft lip and palate (BCLP, 134), and non-cleft controls (NCLP, 134). Skeletal maturation stages were assessed using the 5-stage cervical vertebral maturation (CVM) method. Adenoidal and tonsil hypertrophy was also assessed based on cephalometric radiographs. Dentition stages were evaluated based on the eruption of mandibular teeth. Logistic regression models were used to analyze the relationship between CLP and skeletal maturation, adjusting for adenoidal and tonsil hypertrophy and sex. The children were further subgrouped by sex, cleft type, and age to examine developmental patterns and the relationship between skeletal maturation and dentition.
Results:
In both sexes, children with CLP exhibited delayed skeletal maturation at specific developmental stages compared to NCLP children, but eventually caught up to their non-cleft peers. This delay and subsequent catch-up occurred approximately three years earlier in girls with CLP than in boys. While dentition stages showed a strong correlation with CVM stages, the diagnostic utility of dentition for assessing skeletal maturation was found to be limited.
Conclusions:
Children with CLP exhibit a delayed onset of the growth spurt, followed by a period of catch-up growth. Additionally, dentition stage should not be used as a surrogate marker for skeletal maturation when evaluating the developmental potential of children with CLP.
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