Maxillary Development in Patients with Unilateral Cleft Lip and Palate Compared with Individuals Having Skeletal Class I and Class III Malocclusion

Aim: To compare maxillary development of individuals with unilateral cleft lip and palate (CLP) to individuals with skeletal Class I and Class III malocclusions. Study design: Cephalometric X-ray films from 90 patients (mean age: 13 ± 2.3 years) were used. The number of samples was determined by Power analysis and three groups consisting of 30 patients (Group 1: Skeletal Class I, Group 2: Skeletal Class III, Group 3: CLP) were formed. A total of 13 cephalometric measurements were performed using Dolphin imaging software 11.7. The Kruskal-Wallis and ANOVA tests were used to calculate the differences. The Dunn test and Bonferroni correction were used in paired group comparisons. Results: SNA, Co-A, A-PTV Horizontal, Na-APog, A-Na-Pog, FH-NA, Sn’-Mx1, MxOP-TVL (p<0.001***), U6-PTV Vertical (p<0.01**), and NaBa PTV-Gn (p<0.05*) values were significantly different between the three groups. There was no significant difference in Na-ANS, FH-NPog, or Mx1 labial-ULA. SNA, Co-A, A-PTV Horizontal, Na-APog, and A-Na-Pog values between the 1st and 2nd groups and between the 1st and 3rd groups (p<0.001***) were significantly different. FH-Na-A, Sn’-Mx1, MxOP-TVL (p<0.001***), and U6-PTV vertical were different between groups 1 and 3 (p<0.01**), while FH-Na-A (p<0.001***), Sn’-Mx1, MxOP-TVL (p<0.01**), A-PTV Horizontal, and A-Na-Pog (p<0.05*) were significantly different between groups 2 and 3. Conclusion: Maxillary development in CLP differs from skeletal Class I but is similar to skeletal Class III. Considering the delay in maxillary development in the CLP patient, maxillary protraction and maxillary expansion are important treatment protocols in the early period.

Unilateral cleft lip and palate; Maxillary development; Skeletal class I; Skeletal class III

1. Cura F, Böhmer AC, Klamt J, Schünke H, Scapoli L, Martinelli M, et al. Replication analysis of 15 susceptibility loci for nonsyndromic cleft lip with or without cleft palate in an Italian population. Birth Defects Res A Clin Mol Teratol 2016;106:81-87.

2. Dixon MJ, Marazita ML, Beaty TH, Murray JC. Cleft lip and palate: understanding genetic and environmental influences. Nat Rev Genet. 2011;12:167–178.

3. Shetye PR. Facial growth of adults with unoperated clefts. Clin Plast Surg 2004;31:361-371.

4. Mars M, Houston WJB. A preliminary study of facial growth and morphology in unoperated male unilateral cleft lip and palate subjects over 13 years of age. Cleft Palate J 1990;27:7–10.

5. Normando ADC, da Silva OG, Jr CL Jr. Influence of surgery on maxillary growth in cleft lip and/or pal- ate patients. J Craniomaxillofac Surg 1992;20:111–118.

6. Semb G, Shaw WC. Facial growth in orofacial clefting disorders. In: Turvey TA, Vig KWL, Fonseca RJ, editors. Facial clefts and craniosynostosis. Philadelphia: W.B. Saunders; 1996;28–56.

7. Berkowitz S. Cleft Lip and Palate Diagnosis and Management, Springer. 2nd Edition, chapter 3: 2006;225-280.

8. Semb G. A study of facial growth in patients with unilateral cleft lip and palate treated by the Oslo CLP team. Cleft Palate Craniofac J 1991: 28; 1-21.

9. Enemark H, Bolund S, Jørgensen I. Evaluation of unilateral cleft lip and palate treatment: long term results. Cleft Palate J 1990;27:354–361.

10. Smahel Z, Betincová L, Mullerová Z et al. Facial growth and development in unilateral complete cleft lip and palate from palate surgery up to adulthood. J Craniofac Genet Dev Biol 1993;13:57–71.

11. Semb G, Rønning E, Åbyholm FE. Twenty years follow-up of 50 patients with unilateral cleft lip and palate. Semin Orthod 2011;17:207–224.

12. Chiu Y-T, Liao Y-F, Chen P K-T. Initial cleft severity and maxillary growth I patients with complete unilateral cleft lip and palate. Am J Orthod Dentofacial Orthop 2011;140: 189–95.

13. Daskalogiannakis J, Mercado A, Russell K et al The Americleft study: an inter-center study of treatment outcomes for patients with unilateral cleft lip and palate. Part 3. Analysis of craniofacial form. Cleft Palate Craniofac J 2011;48:252–258.

14. Bardach J, Bakowska J, McDermott-Murray J et al. Lip pressure changes following lip repair in infants with unilateral clefts of the lip and palate. Plast Reconstr Surg 1984;74:476–479.

15. Tinano, MM, Martins, MA, Bendo, CB, Mazzieiro, E. Base of the skull morphology and Class III malocclusion in patients with unilateral cleft lip and palate. Dental Press J Orthod. 2015;20(1):79–84.

16. Marcusson A, Paulin G. Changes in occlusion and maxillary dental arch dimensions in adults with treated unilateral complete cleft lip and palate: a follow-up study. Eur J Orthod 2004;26:385–390.

17. Khanna R, Tikku T, Verma SL, Verma G, Dwivedi S. Comparison of maxillofacial growth characteristics in patients with and without cleft lip and palate. J Cleft Lip Palate Craniofac Anomal 2020;7:30-42.

18. Paulin G, Thilander B. Dentofacial relations in 1509 young adults with unilateral cleft lip and palate. 1510 A follow-up study. Scand J Plast Reconstr Surg Hand 1511 Surg 1991; 25:63–72.

19. Friede H, Enemark H. Long-term evidence for favourable midfacial growth after delayed hard palate repair in 1267 UCLP patients. Cleft Palate Craniofac J 2001;38:323–329

20. Nollet PJPM, Katsaros C, Huyskens RWF et al. Cephalometric evaluation of long-term craniofacial development in unilateral cleft lip and palate patients treated with delayed hard palate closure. Int J Oral Maxillofac Surg 2008;37:123–130

21. Meazzini MC, Giussani G, Morabito A et al. A cephalometric intercenter comparison of patients with unilateral cleft lip and palate: analysis at 5 and 10 years of age and long term. Cleft Palate Craniofac J 2008;45:654–660

22. Gnoinski WM, Rutz G. A longitudinal cephalomet- 1307 ric study from age 5 to 18 years on individuals with complete bilateral cleft lip and palate. J Craniofac 1309 Surg 2009;20:1672–1682.

23. Lilja J, Mars M, Elander A et al. Analysis of dental arch relationships in Swedish unilateral cleft lip and palate subjects: 20-year longitudinal consecutive series treated with delayed hard palate closure. Cleft Palate Craniofac J 2006;43:606–611.

24. Li Y, Shi B, Song QG, Zuo H, Zheng Q. Effects of lip repair on maxillary growth and facial soft tissue development in patients with a complete unilateral cleft of lip, alveolus, and palate. J Craniomaxillofac Surg. 2006;34:355–361.

25. Liao YF, Mars M. Hard palate repair timing and facial growth in cleft lip and palate: a systematic review. Cleft Palate Craniofac J. 2006;43: 563–570.

26. Liao YF, Mars M. Long-term effects of lip repair on dentofacial morphology in patients with unilateral cleft lip and palate. Cleft Palate Craniofac J. 2005;42:526–532.

27. Richard B, Russell J, McMahon S, Pigott R. Results of randomized controlled trial of soft palate first versus hard palate first repair in unilateral complete cleft lip and palate. Cleft Palate Craniofac J. 2006;43:329–338.

28. Shetye PR, Evans CA. Midfacial morphology in adult unoperated complete unilateral cleft lip and palate patients. Angle Orthod. 2006;76: 810–816.