A multicenter retrospective 3D study of serial complete unilateral cleft lip and palate and complete bilateral cleft lip and palate casts to evaluatetreatment: Part 1 - The participating institutions and research aims

Objective: To compare the multicenter retrospective and prospective spaciot emporal (4D) serial analyses of complete unilateral (CUCLP) and complete bi lateral (CBCLP) cleft lip and palate casts that had undergone different tre atment procedures. The involved institutions are Miami Craniofacial Anomali es Foundation, South Florida Cleft Palate Clinic; University Hospital of Ni jmegen Cleft Palate Center; Free University of Amsterdam Cleft Palate Cente r; Academic Hospital (Dijkzigt/Sophia) Rotterdam Cleft Palate Center; Cente r for Craniofacial Anomalies, University of Illinois College of Medicine; C left Palate Center, Sahlgrenska University Hospital, Goteborg, Sweden; and Children's Memorial Medical Center, Northwestern University Cleft Palate In stitute. Design: Using serial casts of the upper jaw and an electromechanical digiti zer with special CadCam software (CadKey), the occlusal relationships and m orphometric palatal growth changes that occur under the influence of presur gical orthopedics and various surgical procedures will be studied. It is an ticipated that 3D geometric data extracted from serial casts will identify the important geometric palatal parameters present before cleft surgical cl osure, which will supply objective criteria for establishing a scientific b asis for improved surgical therapy. This research study will test three hypotheses: (1) Conservative (varying t he timing of surgical cleft closure according to the size of the cleft spac e) lip and palatal surgery will permit "catch-up" palatal growth and normal ize palatal growth and development. (2) The amount of mucoperiosteal tissue relative to the size of the cleft space is important in determining the ti ming of palatal surgery, as it influences the degree of scarring and ultima tely the palate's adult size and form. (3) Presurgical orthopedics (the use of appliances soon after birth) can stimulate palatal growth beyond its no rmal growth potential, Results: In a previous project and again after reviewing the data already c ollected during the first year of this study, it has been shown that increm ental changes in size of palatal segments in CUCLP and CBCLP cases prior to surgery vary slightly, The CBCLP cases grow slightly faster than CUCLP cas es before surgery, but growth of the CBCLP cases decreases in acceleration after surgery. Reasons for these differences will be determined when more c ases are analyzed and subjected to biostatistical analysis.