The impact of cleft lip and palate repair on maxillofacial growth

Abstract

The timing of hard palate closure is important for preserving the normal growth of the upper jaw (maxilla) and palate after cleft surgery. Cleft surgeons are concerned surgery will restrict growth of the maxilla. Led by Shi Bing from the West China School of Stomatology in Sichuan, the researchers reviewed studies on surgically related growth inhibition among cleft patients. The extent of growth restriction in cleft lip repair is related to the severity of the original deformity, whereas in palate repair it is related to early reconstruction. A 25-year follow-up study found that 60% of patients had normal maxillary growth when their soft palate was repaired at 4–6 months and hard palate closure was delayed until 18–24 months. Another study by the review authors found the timing of hard palate closure affects post-operative growth.

Keywords

cleft / growth / maxilla / surgical repair

References

[1] Hayashi I, Sakuda M, Takimoto K. Craniofacial growth in complete unilateral cleft lip and palate: a roentgeno-cephalometric study. Cleft Palate J, 1976, 13: 215-237.

[2] Hotz MM, Gnoinski WM. Effects of early maxillary orthopaedics in coordination with delayed surgery for cleft lip and palate. J Maxillofac Surg, 1979, 7(3): 201-210.

[3] Friede H. Growth sites and growth mechanisms at risk in cleft lip and palate. Acta Odontol Scand, 1998, 56(6): 346-351.

[4] Normando AD, da Silva Filho OG, Capelozza Filho L. Influence of surgery on maxillary growth in cleft lip and/or palate patients. J Craniomaxillofac Surg, 1992, 20(3): 111-118.

[5] Graber TM. The congenital cleft palate deformity. J Am Dent Assoc, 1954, 48(4): 375-395.

[6] Jolleys A. A review of the results of operations on cleft palates with reference to maxillary growth and speech function. Br J Plast Surg, 1954, 7(3): 229-241.

[7] Osborne HA. A serial cephalometric analysis of facial growth in adolescent cleft palate subjects. Angle Orthod, 1966, 36(3): 211-223.

[8] Shibasaki Y, Ross RB. Facial growth in children with isolated cleft palate. Cleft Palate J, 1969, 6: 290-302.

[9] Dahl E. Craniofacial morphology in congenital clefts of the lip and palate. An x-ray cephalometric study of young adult males. Acta Odontol Scand, 1970, 28(Suppl 57): 11+.

[10] Bishara SE, Iversen WW. Cephalometric comparisons on the cranial base and face in individuals with isolated clefts of the palate. Cleft Palate J, 1974, 11: 162-175.

[11] Ye ZT, Xu X, Ahmatjian A. The craniofacial morphology adult patients with unoperated isolated cleft palate. Bone Res, 2013, 1(2): 195-200.

[12] Harvold E. Cleft lip and palate: morphologic studies of the facial skeleton. Am J Orthod, 1954, 40: 493-506.

[13] Coupe TB . A study of the morphology and growth of the nasal septum in children with clefts of the lip and palate. Toronto: University of Toronto, 1962.

[14] Graber TM. A study of craniofacial growth and development in the cleft palate child from birth to six years of age//Hotz R ed. Early treatment of cleft lip and palate, 1964 Bern: Hans Huber 30-43.

[15] Ross RB, Coupe TB. Craniofacial morphology in six pairs of monozygotic twins discordant for cleft lip and palate. J Can Dent Assoc (Tor), 1965, 31: 149-157.

[16] Mars M, Houston WJ. A preliminary study of facial growth and morphology in unoperated male unilateral cleft lip and palate subjects over 13 years of age. Cleft Palate J, 1990, 27(1): 7-10.

[17] Capelozza Júnior L, Taniguchi SM, da Silva Júnior OG. Craniofacial morphology of adult unoperated complete unilateral cleft lip and palate patients. Cleft Palate Craniofac J, 1993, 30(4): 376-381.

[18] Capelozza Júnior L, Taniguchi SM, da Silva Júnior OG. Craniofacial morphology of adult unoperated complete unilateral cleft lip and palate patients. Cleft Palate Craniofac J, 1993, 30(4): 376-381.

[19] Bishara SE, Krause CJ, Olin WH. Facial and dental relationships of individuals with unoperated clefts of the lip and/or palate. Cleft Palate J, 1976, 13: 238-252.

[20] Matsuo K, Hirose T. Preoperative non-surgical over-correction of cleft lip nasal deformity. Br J Plast Surg, 1991, 44(1): 5-11.

[21] Grayson BH, Santiago PE, Brecht LE. Presurgical nasoalveolar molding in infants with cleft lip and palate. Cleft Palate Craniofac J, 1999, 36(6): 486-498.

[22] Grayson BH, Cutting CB. Presurgical nasoalveolar orthopedic molding in primary correction of the nose, lip, and alveolus of infants born with unilateral and bilateral clefts. Cleft Palate Craniofac J, 2001, 38(3): 193-198.

[23] Pai BC, Ko EW, Huang CS. Symmetry of the nose after presurgical nasoalveolar molding in infants with unilateral cleft lip and palate: a preliminary study. Cleft Palate Craniofac J, 2005, 42(6): 658-663.

[24] Liou EJ, Subramanian M, Chen PK. The progressive changes of nasal symmetry and growth after nasoalveolar molding: a three-year follow-up study. Plast Reconstr Surg, 2004, 114(4): 858-864.

[25] Maull DJ, Grayson BH, Cutting CB. Long-term effects of nasoalveolar molding on three-dimensional nasal shape in unilateral clefts. Cleft Palate Craniofac J, 1999, 36(5): 391-397.

[26] Bennun RD, Perandones C, Sepliarsky VA. Nonsurgical correction of nasal deformity in unilateral complete cleft lip: a 6-year follow-up. Plast Reconstr Surg, 1999, 104(3): 616-630.

[27] Ezzat CF, Chavarria C, Teichgraeber JF. Presurgical nasoalveolar molding therapy for the treatment of unilateral cleft lip and palate: a preliminary study. Cleft Palate Craniofac J, 2007, 44(1): 8-12.

[28] Yang C, Huang N, Shi B. [Clinical research of presurgical orthodontic treatment of complete cleft lip and palate infant.]. Hua Xi Kou Qiang Yi Xue Za Zhi, 2011, 29(4): 396-399.

[29] Santiago PE, Grayson BH, Cutting CB. Reduced need for alveolar bone grafting by presurgical orthopedics and primary gingivoperiosteoplasty. Cleft Palate Craniofac J, 1998, 35(1): 77-80.

[30] Wood RJ, Grayson BH, Cutting CB. Gingivoperiosteoplasty and midfacial growth. Cleft Palate Craniofac J, 1997, 34(1): 17-20.

[31] Ross RB. Growth of the facial skeleton following the Malek repair for unilateral cleft lip and palate. Cleft Palate Craniofac J, 1995, 32(3): 194-198.

[32] Ras F, Habets LL, van Ginkel FC. Longitudinal study on three-dimensional changes of facial asymmetry in children between 4 to 12 years of age with unilateral cleft lip and palate. Cleft Palate Craniofac J, 1995, 32(6): 463-468.

[33] Koberg W, Koblin I. Speech development and maxillary growth in relation to technique and timing of palatoplasty. J Maxillofac Surg, 1973, 1(1): 44-50.

[34] Graber TM. Changing philosophies in cleft palate management. J Pediatr, 1950, 37(3): 400-415.

[35] Ross RB. Treatment variables affecting facial growth in complete unilateral cleft lip and palate. Cleft Palate J, 1987, 24(1): 5-77.

[36] Pirruccello FW. Cleft lip and palate, 1987 Springfield: Chareles C Thomas Publisher 9.

[37] Samman N, Cheung LK, Tideman H. A comparison of alveolar bone grafting with and without simultaneous maxillary osteotomies in cleft palate patients. Int J Oral Maxillofac Surg, 1994, 23(2): 65-70.

[38] Bergland O, Semb G, Abyholm FE. Elimination of the residual alveolar cleft by secondary bone grafting and subsequent orthodontic treatment. Cleft Palate J, 1986, 23(3): 175-205.

[39] Gesch D, Kirbschus A, Mack F. Comparison of craniofacial morphology in patients with unilateral cleft lip, alveolus and palate with and without secondary osteoplasty. J Craniomaxillofac Surg, 2006, 34(Suppl 2): 62-66.

[40] Levitt T, Long RE Jr, Trotman CA. Maxillary growth in patients with clefts following secondary alveolar bone grafting. Cleft Palate Craniofac J, 1999, 36(5): 398-406.

[41] Li Y, Shi B, Song QG. Effects of lip repair on maxillary growth and facial soft tissue development in patients with a complete unilateral cleft of lip, alveolus and palate. J Craniomaxillofac Surg, 2006, 34(6): 355-361.

[42] Meng T, Shi B, Wang Q. A comparative study of maxillary growth following rotation-advancement and triangular flap unilateral cleft lip repairs: an experimental study in rabbits. Ann Plast Surg, 2007, 58(4): 434-440.

[43] Birch J, Ross RB, Lindsay WK. The end result of growth and treatment in bilateral complete cleft lip and palate. Panminerva Med, 1967, 9: 391-397.

[44] Narula JK, Ross RB. Facial growth in children with complete bilateral cleft lip and palate. Cleft Palate J, 1970, 7: 239-248.

[45] Pichler H. [Zur operation der doppeltenlippen-gaumenspalten.]. Deutsch Z Cir, 1926, 195: 104-107.

[46] Friede H, Johanson B. A follow-up study of cleft children treated with vomer flap as part of a three-stage soft tissue surgical procedure. Facial morphology and dental occlusion. Scand J Plast Reconstr Surg, 1977, 11(1): 45-57.

[47] Mølsted K, Palmberg A, Dahl E. Malocclusion in complete unilateral and bilateral cleft lip and palate. The results of a change in the surgical procedure. Scand J Plast Reconstr Surg Hand Surg, 1987, 21(1): 81-85.

[48] Leow AM, Lo LJ. Palatoplasty: evolution and controversies. Chang Gung Med J, 2008, 31(4): 335-345.

[49] Delaire J, Precious D. Avoidance of the use of vomerine mucosa in primary surgical management of velopalatine clefts. Oral Surg Oral Med Oral Pathol, 1985, 60(6): 589-597.

[50] Ross RB. Treatment variables affecting facial growth in complete unilateral cleft lip and palate. Cleft Palate J, 1987, 24(1): 5-77.

[51] Jackson O, Stransky CA, Jawad AF. The Children’s Hospital of Philadelphia modification of the Furlow double-opposing Z-palatoplasty: 30-year experience and long-term speech outcomes. Plast Reconstr Surg, 2013, 132(3): 613-622.

[52] Losee JE, Kirschner RE. Comprehensive cleft care, 2009 New York: McGraw-Hill 371-390.

[53] Chate R, DiBiase D, Ball J. A comparison of the dental occlusions from a United Kingdom sample of complete unilateral cleft lip and palate patients with those from the Eurocleft Study. Transactions of the 8th International Congress on Cleft palate and Related Craniofacial Anomalies, 1997 Singapore: Stamford Press, Academy of Medicine 371-376.

[54] Long RE Jr, McNamara JA Jr. Facial growth following pharyngeal flap surgery: skeletal assessment on serial lateral cephalometric radiographs. Am J Orthod, 1985, 87(3): 187-196.

[55] Voshol IE, van Adrichem LN, van der Wal KG. Influence of pharyngeal flap surgery on maxillary outgrowth in cleft patients. Int J Oral Maxillofac Surg, 2013, 42(2): 192-197.

[56] Heliövaara A, Haapanen ML, Hukki J. Long-term effect of pharyngeal flap surgery on craniofacial and nasopharyngeal morphology in patients with cleft palate. Acta Odontol Scand, 2003, 61(3): 159-163.

[57] Schweckendiek W, Doz P. Primary veloplasty: long-term results without maxillary deformity: a twenty-five year report. Cleft Palate J, 1978, 15(3): 268-274.

[58] Bardach J, Morris HL, Olin WH. Late results of primary veloplasty: the Marburg Project. Plast Reconstr Surg, 1984, 73(2): 207-218.

[59] Hotz MM, Gnoinski WM, Nussbaumer H. Early maxillary orthopedics in CLP cases: guidelines for surgery. Cleft Palate J, 1978, 15(4): 405-411.

[60] Lilja J, Mars M, Elander A. Analysis of dental arch relationships in Swedish unilateral cleft lip and palate subjects: 20-year longitudinal consecutive series treated with delayed hard palate closure. Cleft Palate Craniofac J, 2006, 43(5): 606-611.

[61] Semb G. A study of facial growth in patients with unilateral cleft lip and palate treated by the Oslo CLP Team. Cleft Palate Craniofac J, 1991, 28(1): 1-21.

[62] Mølsted K, Asher-McDade C, Brattström V. A six-center international study of treatment outcome in patients with clefts of the lip and palate: Part 2. Craniofacial form and soft tissue profile. Cleft Palate Craniofac J, 1992, 29(5): 398-404.

[63] del Guercio F, Meazzini MC, Garattini G. A cephalometric intercentre comparison of patients with unilateral cleft lip and palate at 5 and 10 years of age. Eur J Orthod, 2010, 32(1): 24-27.

[64] Liao YF, Yang IY, Wang R. Two-stage palate repair with delayed hard palate closure is related to favorable maxillary growth in unilateral cleft lip and palate. Plast Reconstr Surg, 2010, 125(5): 1503-1510.

[65] Mommaerts MY, Combes FA, Drake D. The Furlow Z-plasty in two-staged palatal repair modifications and complications. Br J Oral Maxillofac Surg, 2006, 44(2): 94-99.

[66] Richard B, Russell J, McMahon S. Results of randomized controlled trial of soft palate first versus hard palate first repair in unilateral complete cleft lip and palate. Cleft Palate Craniofac J, 2006, 43(3): 329-338.