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Growth pattern prediction of maxillary segments in infants with unilateral cleft lip and palate: a prospective in
Sarah Bühling1, Cedric Thedens2, Sara Eslami2
1Department of Orthodontics, Johann-Wolfgang Goethe University, Frankfurt, Germany. buehling@med.uni-frankfurt.de.
Insights
A linear regression model best predicts maxillary segment growth in infants with unilateral cleft lip and palate before surgery. This model aids in planning treatment for these patients.
Area of Science:
- Craniofacial development
- Pediatric surgery
- Orthodontics
Background:
- Infants with unilateral cleft lip and palate (UCLP) require timely surgical intervention.
- Accurate prediction of maxillary growth is crucial for effective presurgical management.
- Alveolar molding therapy is commonly used to prepare the cleft area before surgery.
Purpose of the Study:
- To determine the optimal predictive model for maxillary segment growth in infants with UCLP.
- To analyze growth patterns from birth up to the primary surgical closure.
- To establish a reliable growth curve for preoperative planning.
Main Methods:
- Collected 195 digital maxillary models from 50 infants with UCLP during presurgical alveolar molding.
- Utilized intraoral scans taken from birth to approximately 6 months of age.
- Applied mixed-effects regression models (fractional polynomials, B-splines) to surface measurements, selecting the best fit using Akaike Information Criterion.
Main Results:
- A linear regression model with mixed effects demonstrated the best fit for total, large segment, and small segment maxillary areas.
- Observed a significant association between surface area and patient age (p < 0.001).
- Estimated daily growth rates: 2.88 mm² (total area), 1.62 mm² (large segment), and 1.25 mm² (small segment).
Conclusions:
- A linear regression model accurately predicts maxillary segment growth in infants with UCLP during the preoperative period.
- The developed growth curve model can inform future treatment strategies for UCLP patients.
- This predictive model enhances presurgical planning for improved outcomes.
Purpose:
The aim of the study was to identify the best prediction model for the growth pattern of the maxillary segments of infants with unilateral cleft lip and palate post birth and prior to the primary surgical cleft closure.
Materials And Methods:
195 digital maxillary models of 50 infants with unilateral cleft lip and palate were collected during their preoperative alveolar molding therapy period. Intraoral scans were taken shortly after birth, at the monthly checkups and just before the surgical cleft closure at approximately 6 months of age. Surface measurements of maxillary segments were conducted using the diagnostic program OnyxCeph³™. For identifying the best fit for the growth pattern, mixed-effects regression models (fractional polynomials and B-splines) with the surface measurement as dependent variable, patient age (days) as predictor and the patient as random effect were fitted to the data. The best fit was selected according to the Akaike Information Criterium. A likelihood ratio test was performed for comparing the selected model with the intercept-only model.
Results:
The linear regression with mixed effects model showed the best fit for the total area, the area of the large segment and the area of the small segment. A highly significant association between the surface area and patient age was observed (p < 0.001). An increase of the area with time was estimated at 2.88 mm2 per day for the total area, 1.62 mm2 per day for the area of the large segment and 1.25 mm2 per day for the area of the small segment. The likelihood ratio tests indicated that the linear regression models were significantly better than the intercept-only models for all the measured areas (p < 0.01).
Conclusion:
The growth pattern for the maxillary segments of patients with unilateral cleft lip and palate in the preoperative period can be best predicted by using a linear regression model. The growth curve model developed by the present study can be used in future treatment planning of patients with unilateral cleft lip and palate.
