COMPARISON OF FACIAL FORM IN PRIMARY ALVEOLAR BONE-GRAFTED AND NONGRAFTED UNILATERAL CLEFT-LIP AND PALATE PATIENTS - INTERCENTER RETROSPECTIVE STUDY

The purpose of this study was to describe and compare posttreatment cr aniofacial morphology in samples of complete unilateral cleft lip and palate (CUCLP) patients treated at two leading clinics: The Children's Memorial Hospital Cleft Palate Clinic, Chicago, Illinois, and the Lan caster Cleft Palate Clinic, Lancaster, Pennsylvania. These centers hav e well-defined treatment protocols that al low the long-term effects o n craniofacial form of the following treatment regimes to be contraste d: (1) Chicago-primary alveolar bone grafting, with definitive lip rep air at age 4 to 6 months and hard and soft palate repair at 6 to 12 mo nths; and (2) Lancaster-definitive triangular-flap lip repair at 3 mon ths of age, followed by staged surgeries of the hard and soft palates, both completed by 18 months of age, but without primary alveolar bone grafting. Although the Lancaster center now performs secondary alveol ar bone grafting, the majority of the patients studied here were treat ed before this procedure became part of their protocol. Patients were eligible for inclusion if they had no other congenital anomalies and n o previous orthodontic treatment. A sample of 43 (24 male, 19 female) CUCLP patients was obtained from the Chicago Center, each of which was then matched to a nongrafted Lancaster CUCLP patient. The matching cr iteria were age, sex, and sella-nasion distance (to control, at least in part, for size differences). Lateral cephalometric radiographs of t hese 86 CUCLP patients were traced, digitized, and analyzed. Additiona lly, all linear data were adjusted to a standard magnification of 8% b ecause the cephalograms from each center featured different enlargemen ts. The Chicago and Lancaster samples had mean posttreatment ages of 1 0.32 years (SD = 1.96) and 10.40 years (SD = 2.18), respectively. The grafted Chicago group had faces that were on average less maxillary pr otrusive compared with the nongrafted Lancaster sample; it appeared, h owever, that the mandible compensated for the maxillary position by do wnward and backward rotation. As a result, a similar maxillomandibular relationship was noted in both groups, although, in the Chicago group , the lower anterior facial height increased.