Craniofacial growth and development in unilateral cleft lip and palate: clinical implications (a review)

The main problem of facial development in cleft palate consists of deficient anterior growth of the upper jaw. Roentgencephalometric data showed that the sagittal jaw relations deteriorated gradually from palate surgery up to adulthood. In spite of this adverse trend of growth, orthodontic therapy succeeded in improving the occlusion of incisors during prepubertal period. However during the pubertal growth spurt occurred an impairment of occlusion which was caused by the depletion of compensatory dentoalveolar mechanisms of the jaws due to the previous orthodontic treatment. An effective compensation of the gradual impairment of sagittal jaw relations can be attained with fixed appliances. These observations showed that the main problems of facial growth in clefts developed only after palate surgery and in particular during puberty. For favourable sagittal jaw relations and the configuration of the facial profile is of paramount importance the restoration of a positive overjet which exerts marked effects on the position of the mandible. On the other hand the configuration of the facial profile and the results of orthodontic therapy are affected by the rotation of the lower jaw and the amount of posterior displacement of the TM joint, which represent inborn growth patterns of the skull. The most favourable developmental situation represents the posterior displacement of the TM joint associated with neutral type of rotation. Therefore, it is of importance to predict the development of these characteristics.