Material and methods

Twenty-seven nonsyndromic patients affected by complete UCLP and 8 patients affected by BCLP who consulted the outpatient clinic of the Department of Orthodontics and Dentofacial Orthopedics at Tokushima University Hospital in Japan from 1990 to 2005 served as our subjects. All patients had cheiloplasty with a triangular flap method approximately 3 months after birth and 1-stage palatoplasty with the push-back method at the mean age of 13 months by 2 senior surgeons of the Department of Reconstructive Plastic Surgery at Tokushima University Hospital. All patients also received infant orthopedic treatment with a palatal device for molding and positioning the alveolar segments (Hotz plate) as described by Hotz and Gnoinski from immediately after the cheiloplasty to just before the palatoplasty. The infant orthopedic treatment was part of the standard protocol in our department.

Records of the UCLP subjects (14 boys, 13 girls; mean age, 5.7 years; SD, 1.1 years) were compared with those of the BCLP subjects (6 boys, 2 girls; mean age, 5.8 years; SD, 1.1 years). The UCLP subjects were divided into 2 groups according to the width of the alveolar cleft immediately after the cheiloplasty (T1). The UCLP-severe group consisted of 14 patients (6 boys, 8 girls; mean age, 5.5 years; SD, 1.0 year) with the width of the alveolar cleft 4.0 mm or more at T1. The UCLP-mild group consisted of 13 patients (8 boys, 5 girls; mean age, 5.9 years; SD, 1.3 years) with the width of the alveolar cleft less than 4.0 mm at T1. No significant differences were observed in the 3 groups at 6 years of age (T2).

This study was approved by the Institutional Ethical Committee of Tokushima University Hospital.

A 3-dimensional measurement system (FN503; Mitutoyo, Kasugai, Aichi, Japan) was used for model analysis at T1 and T2. Reproducible reference points were defined according to those of Kramer et al ( Fig 1 ). A triaxial reference system was defined by an x-y plane containing the bilateral tuberosity points and the incisal point. The midpoint between both tuberosity points was the origin. All reference points were translated into 3-dimensional coordinates, and all measurements were calculated based on the coordinates.

Reference points on plaster models: A, before palatoplasty, C and C′ indicate the canine points on the top of the alveolar crest where the lateral sulcus and lateral frenulum meet; I , the incisal point on the top of the alveolar crest where the incisal papilla and labial frenulum meet; L , the anterior lateral segment point at the margin of the alveolar process lateral to the cleft; P , the premaxillary point at the margin of the alveolar process medial to the cleft; T and T′ , the tuberosity points at the junction of the alveolar ridge with the outline of the tuberosity. The triaxial reference system was defined by an x-y plane containing the bilateral tuberosity points and incisal point. The midpoint between both tuberosity points was the origin. B, At 6 years of age, C and C′ indicate the canine points on the gingival margin at the buccal prominence of the deciduous canines; I , the incisal point on the top of the gingiva at the contact points of the deciduous central incisors; E and E′ , the molar points on the gingival margin at the buccal prominence of the deciduous second molar; L , the anterior lateral segment point at the margin of the alveolar process lateral to the cleft; P , the premaxillary point at the margin of the alveolar process medial to the cleft; T and T′ , the tuberosity points at the junction of the alveolar ridge with the outline of the tuberosity.

Three widths (P-L, width of the alveolar cleft; C-C′, anterior arch width; and T-T′, posterior arch width at the tuberosity points) were measured in the models at T1. Nine linear measurements (P-L, C-C′, T-T′, E-E′, posterior arch widths at the molars; I ⊥ TT′, arch depth; C-ITT′, alveolar height at the canine point on the major segment; C′-ITT′, alveolar height at the canine point on the minor segment; E-ITT′, alveolar height at the molar point on the major segment; and E′-ITT′, alveolar height at the molar point on the minor segment) and 4 angular measurements (CTT′, C′T′T, ITT′, and IT′T) were analyzed in the models at T2. The width of the alveolar cleft in the BCLP subjects was indicated as the mean value of both alveolar clefts. Alveolar heights were defined as the distances from the each reference points to the x-y plane.

The lateral cephalograms at T2 were traced on acetate paper, and measurements of craniofacial morphology were made. Nine linear and 10 angular measurements were analyzed morphometrically and compared with the skeletal characteristics and the Japanese cephalometric norms ( Figs 2 and 3 ).

Linear measurements: 1 , anterior cranial base (S-N); 2 , anterior facial height (N-Me); 3 , upper anterior facial height (N-PP); 4 , lower anterior facial height (Me-PP); 5 , upper posterior facial height (S-PP); 6 , maxillary length (distance between PTM and ANS referred to the palatal plane, PTM-ANS/PP); 7 , mandibular length (Ar-Me); 8 , mandibular ramus height (Ar-Go); 9 , mandibular body length (Go-Me).

Angular measurements: 1 , N-S-Ba; 2 , FH-SN; 3 , facial angle; 4 , y-axis; 5 , ANB; 6 , SNA; 7 , SNB; 8 , palatal plane angle (PP-SN); 9 , mandibular plane angle (MP-SN); 10 , gonial angle.

To eliminate interobserver error and ensure standardization, all measurements were made by 1 investigator (Y.T.). Intraobservation reliability was calculated by measuring all variables 2 weeks apart. A paired t test for the reproducibility of the measurements showed no significant differences between the variables measured 2 weeks apart, indicating that the variables were reproducible. The casual error was calculated according to Dahlberg’s formula (Se ² ∑d ² /2n), where Se ² was the error variance, d was the difference between the repeated measurements, and n was the number of double measurements. According to the formula, the mean errors were 0.06 to 0.32 mm for the linear measurements and 0.22° to 0.54° for the angular measurements.

Results

In the cephalometric analyses at T2, the maxillary length (PTM-ANS/PP) and the upper anterior facial height (N-PP) were significantly smaller ( P <0.05), and the facial angle was significantly greater in the UCLP group than in the BCLP group ( P <0.001; Fig 4 , A ; Table I ).

Mean profilograms in the BCLP and UCLP groups at T2 superimposed on the Japanese norms at 6 years of age ( dotted lines ). A, UCLP group ( red lines ); BCLP group ( blue lines ). B, UCLP-mild group ( orange lines ); UCLP-severe group ( red lines) . All profilograms are superimposed on the sella-nasion plane at sella.

The mean values of the upper posterior facial height (S/PP) and the palatal plane angle (PP-SN) in both the BCLP and UCLP groups were out of the normal range, as previously reported. A short maxillary length with a small ANB angle because of a small SNA angle was observed in the UCLP group, and tendencies for greater maxillary length, enlarged y-axis, steeper mandibular plane (MP-SN), and longer total anterior facial height (N-Me) were shown in the BCLP group (these characteristics were compared with the normal values but not analyzed statistically; Fig 4 , A , and Table I ).

In the UCLP-mild group, the upper posterior facial height ( P <0.01), the total ( P <0.05) and lower ( P <0.01) anterior facial heights, and mandibular length (Ar-Me, P <0.01; Go-Me, P <0.05) were significantly greater, and the palatal plane angle was smaller than those in the UCLP-severe group ( P <0.05; Fig 4 , B ; Table II ).

Table II

Comparison of cephalometric analyses between the UCLP groups at 6 years old

Variable	Japanese norm ∗		UCLP-mild		UCLP-severe		P value UCLP-mild vs UCLP-severe †
	Mean	SD	Mean	SD	Mean	SD
Linear measurements (mm)
S-N	62.6	2.5	62.4	3.0	62.0	3.2	0.9613
N-Me	104.7	3.8	105.5	6.6	99.5	4.8	0.0101 ‡
N/PP	44.9	1.8	44.5	3.4	42.8	2.3	0.1089
Me/PP	57.2	3.1	59.5	3.4	55.4	3.1	0.0042 §
S/PP	37.5	2.5	34.2	3.1	30.0	4.0	0.0066 §
PTM-ANS/PP	46.3	2.0	44.6	3.3	44.3	3.1	0.8842
Ar-Me	87.2	3.7	87.9	5.1	83.3	4.2	0.0082 §
Ar-Go	36.7	2.4	38.2	3.8	36.1	3.2	0.0848
Go-Me	57.9	3.5	57.9	4.1	54.7	3.6	0.0415 ‡
Angular measurements (°)
N-S-Ba	130.7	4.7	133.2	4.4	134.9	4.6	0.3436
FH-SN	6.7	2.5	6.4	2.4	6.2	1.6	0.8460
Facial angle	81.6	1.8	82.0	2.9	80.3	2.6	0.0892
Y-axis	65.6	2.7	65.0	3.5	64.8	3.0	0.9034
ANB	4.9	2.0	0.6	2.3	0.3	2.8	0.7157
SNA	81.4	2.6	76.7	2.6	75.4	4.7	0.4094
SNB	76.4	2.6	76.1	2.9	75.1	3.6	0.5765
PP-SN	7.0	2.8	9.5	1.7	12.0	3.3	0.0198 ‡
MP-SN	40.2	4.1	37.3	4.4	38.0	5.9	0.5440
Gonial angle	130.0	4.7	127.7	5.7	128.8	5.8	0.5441

Only gold members can continue reading. Log In or Register to continue

Share this:

• Click to share on Twitter (Opens in new window)
• Click to share on Facebook (Opens in new window)

Related

Related posts:

1. Parameters of care for craniosynostosis: Dental and orthodontic perspectives
2. Residents’ journal review
3. Three-dimensional analysis of the pharyngeal airway morphology in growing Japanese girls with and without cleft lip and palate
4. Interdisciplinary treatment of an adult with complete bilateral cleft lip and palate
5. Ideal treatment protocol for cleft lip and palate patient from mixed to permanent dentition
6. Orthodontic and surgical treatment of a patient with hemifacial microsomia

Stay updated, free dental videos. Join our Telegram channel

Join