Cleft lip and palate treated by presurgical orthopedics, gingivoperiosteoplasty, and lip adhesion (POPLA) compared with previous lip adhesion method:A preliminary study of serial dental casts

Comparing the treatment protocols for cleft lip and palate requires a study of facial growth and development. Serial orthodontic study models aid in d elineating the effects of surgery on maxillary mandibular relationships. In 1978, a new protocol, POPLA (presurgical orthopedics followed by periosteo plasty and lip adhesion), was del el oed and put into practice. This articl e compares the results obtained using POPLA (group I) with those using the previous method (lip adhesion alone) (group II) for cases of unilateral and bilateral clefts. Complete orthodontic study models were available for 124 patients, 63 in group I and 61 in group II. Specific timing sequences and surgical details are discussed. Dental cast analyses evaluated alveolar gap, arch width, anteroposterior di stance, incisor crossbite (single tooth and multiple tooth), and buccal cro ssbite (single and multiple tooth) at birth and at 3, 6, and 9 years of age . X-ray studies evaluated the bull bridge. Additional comments are made reg arding the incidents and effects of pharyngeal naps and bone grafts on maxi llary-mandibular relationships. Results included less buccal crossbite in t he POPLA group, with a wider transverse distance of the upper dental arch. The was a greater frequency of anterior crossbite in the POPLA group, and t he anteroposterior distance was shorter at 6 years of age but less so by ag e 9. This may be because of the different orthodontic care received by the patients in the two groups. In conclusion, the POPLA approach achieves the main goal of moving the pala te into a normal position and stabilizing the arch with a bony bridge that attracts teeth. It avoids the difficult anterior fistulae and presents a mo re symmetrical platform upon which the lip can be united and the nose can b e corrected early.