Facial growth and development in unilateral complete cleft lip and palate from palate surgery up to adulthood

Mixed longitudinal and cross-sectional roentgen-cephalometric data were used for studies of the growth and development of the face in unilateral complete cleft lip and palate from the time of primary palatoplasty up to adulthood. The results were compared with the data obtained in controls at the age of 5 years and in adults. The vertical growth of the upper and lower face exceeded its sagittal growth. The lower face showed a higher growth rate in both directions than did the upper face. The depth of the maxilla showed the lowest growth rate. The height of the upper lip increased very little as well. The most important deviation in facial development consisted of the deficient growth of maxillary depth and the prolongation of the lower face. Both these deviations develop predominantly after palate surgery and the former resulted in a gradual retrusion of the maxilla, a flattening of the face, and impairment of sagittal jaw relations. The reduction of upper face height, the posterior position of the maxilla, and the shortening of the mandible (both of the body and ramus) represented, on the contrary, early changes. The a persisting posterior rotation of the mandible, changes in the shape of the mandible, and vertical disproportion of the face increased with age, the steep slope of the mandibular body remaining at the level ascertained in early childhood. An improvement in the occlusion of incisors was obtained prior to the age of 12 years, but it regressed during the period of puberty. The prominence of the upper lip gradually decreased and the lip was short.