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Changes in craniofacial development due to modifications of the treatment of unilateral cleft lip and palate
Z Smahel1, Z Müllerova, A Nejedly
1Faculty of Natural Sciences, Charles University, Institute of Experimental Medicine of the Academy of Sciences of the Czech Republic, Prague.
Insights
Effective orthodontic treatment significantly improved craniofacial development in children with unilateral cleft lip and palate (UCLP). Different surgical techniques impacted maxillary growth, with periosteoplasty showing better outcomes than bone grafting.
Area of Science:
- Craniofacial surgery
- Orthodontics
- Pediatric plastic surgery
Background:
- Unilateral cleft lip and palate (UCLP) management has evolved over decades.
- Understanding the long-term craniofacial outcomes of different historical treatment protocols is crucial for current practice.
Purpose of the Study:
- To evaluate the craniofacial morphology of UCLP patients treated with varying protocols between 1945 and 1976.
- To compare the effects of different surgical and orthodontic interventions on facial growth.
Main Methods:
- Retrospective and longitudinal assessment of 84 adult males with complete UCLP.
- Comparison of four patient groups based on birth year and treatment era.
- Analysis of craniofacial morphology influenced by surgical repair of alveolar process, lip, and palate, alongside orthodontic management.
Main Results:
- Early treatment (1945-1955) without centralized orthodontics resulted in mandibular overclosure and anterior crossbite.
- Centralized orthodontics improved jaw relations but did not alter maxillary retrusion.
- Primary bone grafting worsened maxillary retrusion, while primary periosteoplasty reduced it, leading to better dentoalveolar outcomes.
Conclusions:
- Orthodontic treatment was the primary driver of improved facial development in UCLP patients.
- Surgical interventions, particularly primary bone grafting, negatively impacted maxillary anterior growth.
- Primary periosteoplasty offered a more favorable outcome for maxillary growth compared to bone grafting.
Objective:
The objective of this study was to evaluate the craniofacial morphology of children with unilateral cleft lip and palate (UCLP) resulting from differing management protocols practiced in Prague from 1945 to 1976.
Design:
The craniofacial morphologies of four groups of patients were compared. Two groups were assessed retrospectively (individuals born from 1945 to 1963), and two groups were followed on a longitudinal basis (individuals born from 1966 to 1976).
Setting:
The study was conducted at the Cleft Lip and Palate Center at the Department of Plastic Surgery, Prague, which has a catchment area population of 6 million.
Patients:
The subjects were a consecutive series of adult males (n = 84) who had complete UCLP without associated malformations.
Interventions:
Patients born from 1945 to 1955 did not receive centralized orthodontic therapy. From 1945 to 1965, the alveolar process in the area of the cleft was not surgically repaired. Primary bone grafting was used for the group born from 1965 to 1972, and primary periosteoplasty was used in the subsequent period. Throughout the period covered by the study, the palate was operated on by pushback and pharyngeal flap surgery. From 1945 to 1965, the lip was repaired initially according to Veau, and later according to Tennison and Randall, and during this time, fixed appliances were used for orthodontic treatment.
Results:
The results for the period from 1945 to 1955 are characterized by mandibular overclosure with anterior crossbite. Centralized orthodontic treatment in the later period improved sagittal jaw relations due to the posterior displacement of the mandible and an edge-to-edge bite was attained, but maxillary retrusion was unchanged. Primary bone grafting increased retrusion of the maxilla, which was compensated by further posterior displacement of the mandible. An edge-to-edge bite was also obtained. Primary periosteoplasty reduced maxillary retrusion, and the marked proclination of the upper dentoalveolar component with fixed appliances resulted in a positive overjet. It was no longer necessary to push the mandible back to the extent required in bone grafting.
Conclusion:
Effective orthodontic treatment made the greatest contribution to improved facial development. It allowed compensation of maxillary retrusion by changes in the position of the mandible or by proclination of the upper dentoalveolar component with fixed appliances. The applied surgical methods using primary bone grafting caused deterioration of the anterior growth of the maxilla.