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Published on: September 19, 2015
Presurgical three-dimensional palatal morphology in children with different cleft types compared to healthy controls
Łukasz Wieprzowski1, Maria Fernandez-Pose2, Benito K Benitez3
1Department of Maxillofacial Surgery, Clinic of Pediatric Surgery, Institute of Mother and Child, Ul. Kasprzaka 17a, 01-211, Warsaw, Poland.
Insights
Presurgical assessment of palatal morphology in cleft patients reveals consistent palatal surface area across cleft types. Surgical challenges in cleft palate repair stem from wider clefts, not tissue deficits.
Area of Science:
- Craniofacial surgery
- Pediatric dentistry
- Plastic surgery
Background:
- Presurgical assessment of palatal morphology offers unbiased insights into cleft palate development.
- Understanding early palatal differences is crucial for effective surgical planning.
Purpose of the Study:
- To investigate variations in palatal morphology among untreated patients with different cleft types before surgical intervention.
- To compare palatal size, surface area, width, length, and premaxilla rotation across various cleft classifications.
Main Methods:
- Utilized 3D software for precise measurements from digital impressions of 150 patients.
- Categorized patients into groups: cleft lip, soft palate cleft, complete cleft palate, unilateral cleft lip and palate (UCLP), bilateral cleft lip and palate (BCLP), and non-cleft controls.
- Employed generalized least squares models for statistical analysis of morphological data.
Main Results:
- Bilateral cleft lip and palate (BCLP) exhibited larger overall palatal size due to premaxilla prominence.
- Posterior palatal width was greater in UCLP and BCLP cases.
- Palatal surface area remained consistent across all cleft types, suggesting width, not depth, is the primary surgical consideration.
Conclusions:
- Palatal surface area is not significantly affected by cleft type, contrary to expectations of tissue deficits.
- Surgical complexity in cleft palate repair is primarily related to bridging the width of the cleft.
- Early morphological assessment aids in understanding the anatomical challenges specific to each cleft type.
Abstract:
Palatal morphology in patients with clefts can be accurately assessed during the presurgical period, providing insights into how cleft type affect palatal development. These early observations are unbiased by treatment, making them broadly applicable. This study aimed to identify differences in palatal morphology among untreated patients with various cleft types before surgery. Primary outcomes included palatal size at the occlusal plane and palatal surface area, while secondary outcomes involved palatal width, length, and premaxilla rotation. Digital impressions from 150 patients (97 males, 53 females) were grouped by cleft type: cleft lip, soft palate cleft, complete cleft palate, unilateral cleft lip and palate (UCLP), bilateral cleft lip and palate (BCLP), and non-cleft controls. Measurements were performed using 3D software, and statistical analysis using a generalized least squares model. Patients with BCLP had a larger palatal size due to the prominent premaxilla, but palatal surface area was similar across groups. The posterior palatal width was wider in UCLP and BCLP, while the width at the canine position was narrower in patients with isolated cleft palate. Palatal surface areas remain consistent across cleft types, indicating that surgical challenges arise from the need to cover wider clefts during repair, rather than from the management of tissue deficits.
