CHANGES IN CRANIOFACIAL DEVELOPMENT DUE TO MODIFICATIONS OF THE TREATMENT OF UNILATERAL CLEFT-LIP AND PALATE

Objective: The objective of this study was to evaluate the craniofacia l morphology of children with unilateral cleft lip and palate (UCLP) r esulting from differing management protocols practiced in Prague from 1945 to 1976. Designs The craniofacial morphologies of four groups of patients were compared. Two groups were assessed retrospectively (indi viduals born from 1945 to 1963), and two groups were followed oar a lo ngitudinal basis (individuals born from 1966 to 1976), Setting: The st udy 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 m ales (n = 84) who had complete UCLP without associated malformations. Interventions: Patients born from 1945 to 1955 did not receive central ized orthodontic therapy, From 1945 to 1965, the alveolar process in t he area of the cleft was not surgically repaired. Primary bone graftin g was used for the group born from 1965 to 1972, and primary periosteo plasty was used in the subsequent period. Throughout the period covere d by the study, the palate was operated on by pushback and pharyngeal flap surgery, From 1945 to 1965, the lip was repaired initially accord ing to Veau, and rater according to Tennison and Randall, and during t his time, fixed appliances were used for orthodontic treatment, Result s: The results for the period from 1945 to 1955 are characterized by m andibular 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 wa s attained, but maxillary retrusion was unchanged, Primary bone grafti ng increased retrusion of the maxilla, which was compensated by furthe r posterior displacement of the mandible. An edge-to-edge bite was als o obtained, Primary periosteoplasty reduced maxillary retrusion, and t he 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. Co nclusions Effective orthodontic treatment made the greatest contributi on to improved facial development It allowed compensation of maxillary retrusion by changes in the position of the mandible or by proclinati on of the upper dentoal-veolar component with fixed appliances. The ap plied surgical methods using primary bone grafting caused deterioratio n of the anterior growth of the maxilla.