Facial growth and development during puberty in unilateral cleft lip and palate: a longitudinal study

Roentgencephalometry was used for longitudinal assessment of facial growth and development in 20 boys and 23 girls (age range 10-15 years), with complete unilateral cleft lip and palate. A marked limitation of growth showed the depth of the upper jaw and the height of the upper lip whereas the most intense growth was present in variables characterizing the prominence of the nose. The growth rate was always higher in boys than in girls who had a more pronounced prognathia of the lower jaw. However, the development of the face proceeded identically in both sexes. In contrast with the increasing protrusion of the lower jaw was the increase of the retrusion of the upper jaw, and this led to a flattening of the facial profile and an impairment of sagittal jaw relations. The excessively steep mandibular body and the vertical disproportion of the face remained unchanged. Sagittal jaw relations deteriorated in three fourths of the patients, facial convexity in more than 90%, and neither condition showed any signs of improvement. It was possible to maintain the overjet at the same level as it was at the beginning of puberty; an improvement was attained with fixed appliances. The little scatter of developmental changes of mandibular rotation and the assessment of some correlations were suggestive of an individually constant postoperative character of facial development in clefts. Correlation coefficients disclosed that a more unfavorable condition at the age of 10 years did not imply a subsequent more marked deterioration of development during puberty. Mandibular rotation was not correlated with facial convexity, sagittal jaw relations, or overjet. The possibility of an improvement of overjet by the use of removable appliances was limited by the development of the ANB angle. The use of fixed appliances led to a reduction of this limitation.