GINGIVOPERIOSTEOPLASTY AND MIDFACIAL GROWTH

The objective of this study was to report the effect of gingivoperiost eoplasty on growth of the midfacial skeleton 6 years following primary surgical repair. Patients with complete unilateral cleft lip and pala te who underwent primary cleft lip and nose repair with and without gi ngivoperiosteoplasty (GPP) were retrospectively compared by means of a lateral cephalogram. Mean age at the time of evaluation was 5.7 years . All patients were treated at the Institute of Reconstructive Plastic Surgery, New York University Medical Center. All surgery and presurgi cal orthopedics was performed by the same surgeon and the same orthodo ntist. Twenty-five consecutively treated patients who presented with c omplete unilateral clefts of the primary and secondary palate were inc luded in the study, Of these, 20 patients were available for 6-year fo llow-up cephalometric documentation and review. All patients received preoperative orthopedics with passive molding appliances, followed by repair of the lip, alveolus, and nose in a single stage at the age of 3 months. The repair was performed using the rotation/advancement tech nique. The difference between the two groups was whether or not gingiv operiosteoplasty was performed. The reason for not performing gingivop eriosteoplasty was incomplete approximation of the alveolar segments u sually due to a late start in beginning therapy. Lateral cephalograms (68.5 months post primary surgery) were obtained and traced. Cranial b ase (S-N), maxilla (ANS-PNS), and mandible (Go-Pg) were digitized for shape coordinate analysis, No significant difference in the mean posit ion of ANS-PNS was found between groups (with or without gingivoperios teoplasty). There was, however, a significant difference in the varian ce of position for the points ANS-PNS between the groups (p<.002). We were unable to observe any difference (anteroposterior or supero-infer ior) in the average position of the hard palate (ANS-PNS) between grou ps. We conclude that gingivoperiosteoplasty results in a more uniform position of the hard palate (ANS-PNS) relative to patients that did no t receive gingivoperiosteoplasty. We were unable to demonstrate any cl ear impairment of maxillary growth in the patients treated with gingiv operiosteoplasty when compared to patients treated without gingivoperi osteoplasty.