Article Data

  • Views 865
  • Dowloads 175

Original Research

Open Access

Factors Responsible for Unfavorable Dental Arch Relationship in non Syndromic Unilateral Cleft Lip and Palate Children

  • Sanjida Haque1
  • Mohammad Khursheed Alam1,*,
  • Mohd Fadhli Khamis1

1School of Dental Science, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia

DOI: 10.17796/1053-4628-41.3.236 Vol.41,Issue 3,May 2017 pp.236-242

Published: 01 May 2017

*Corresponding Author(s): Mohammad Khursheed Alam E-mail:


Objectives: Multiple factors are whispered to be crucial cause of unfavourable dental arch relationship in cleft lip and palate (CLP).This study aims to evaluate the dental arch relationship of Bangladeshi children with non syndromic unilateral cleft lip and palate (UCLP) following cheiloplasty and palatoplasty. Also to explore the various congenital (UCLP type, UCLP side, family history of cleft, family history of class III) and environmental (cheiloplasty, palatoplasty) factors that affects dental arch relationship of UCLP patients. Study design: This was a retrospective study where 84 dental models were taken before orthodontic treatment and alveolar bone grafting. The mean age was 7.69± 2.46 (mean± SD). The dental arch relationship was assessed by GOSLON (Great Ormond Street, London and Oslo) Yardstick. According to GOSLON Yardstick, five categories are rated; named- 1: excellent; 2: good; 3: fair; 4: poor; 5: very poor. Also the groups have been dichotomized into favorable (category ratings 1–3) and unfavorable (category ratings 4 and 5) groups. Kappa statistics was used to evaluate the intra- and inter-examiner agreements and logistic regression analysis was used to explore the responsible factors that affect dental arch relationship. Results: Total 37 subjects (44% of all subjects) were categorized into unfavourable group (category rating 4 and 5) using GOSLON yardstick. Intra- and inter-examiner agreements were very good. The mean GOSLON score was 3.238. Using crude and stepwise backward regression analysis, significant association was found between family history of skeletal class III malocclusion (p = 0.015 and p = 0.014 respectively) and unfavourable dental arch relationship. Complete UCLP (p = 0.054) and left sided UCLP (p = 0.053) also seemed to be correlated but not significant with unfavourable dental arch relationship using crude and stepwise backward regression analysis respectively. Conclusion: This analysis suggested that family history of skeletal class III was significantly correlated with unfavourable dental arch relationship of Bangladeshi UCLP children.


Unilateral cleft lip and palate; Dental arch relationship; GOSLON Yardstick

Cite and Share

Sanjida Haque,Mohammad Khursheed Alam,Mohd Fadhli Khamis. Factors Responsible for Unfavorable Dental Arch Relationship in non Syndromic Unilateral Cleft Lip and Palate Children. Journal of Clinical Pediatric Dentistry. 2017. 41(3);236-242.


1. Sekhon PS, Ethunandan M, Markus AF, Krishnan G, Rao CB. Congenital anomalies associated with cleft lip and palate-an analysis of 1623 consec-utive patients. Cleft Palate Craniofac J;48(4):371-8. 2011.

2. Marazita ML. The evolution of human genetic studies of cleft lip and cleft palate. Annu Rev Genomics Hum Genet;13: 263-83. 2012.

3. Haque S, Alam MK, Basri R. Gene involvement in cleft lip and palate (CLP) patients. Bangladesh J Med Sci;14(1): 113-116. 2015.

4. Haque S and Alam MK. Common Dental Anomalies in Cleft Lip and Palate Patients. Malaysian J Med Sci;22(2): 55-60. 2015.

5. Cooper ME, Ratay JS, Marazita ML. Asian oral-facial cleft birth preva-lence. Cleft Palate Craniofac J;43: 580–9. 2006.

6. Agbenorku P, Agbenorku M, Iddi A, Abude F, Sefenu R, Matondo P, Schneider W. A study of cleft lip/palate in a community in the South East of Ghana. Eur J PlastSurg;34(4): 267–272. 2011.

7. Mars M, Plint DA, Houston WJB, Bergland O, Semb G. The GOSLON Yardstick: A new system of assessing dental arch relationships in children with unilateral clefts of the lip and palate. Cleft Palate J;24(4):314–322. 1987.

8. Atack N, Hathorn I, Mars M, Sandy J. Study models of 5 year old children as predictors of surgical outcome in unilateral cleft lip and palate. Euro J Orthod;19(2):165–170. 1997a.

9. Friede H, Enemark H, Semb G, Paulin G, Abyholm F, Bolund S, Lilja J, Ostrup L. Craniofacial and occlusal characteristics in unilateral cleft lip and palate patients from four Scandinavian centres. Scand J PlastRecon-strSurg Hand Surg;25(3):269–76. 1991.

10. Fudalej P, Katsaros C, Dudkiewicz Z, Offert B Piwowar W, Kuijpers M, Kuijpers-Jagtman AM. Dental arch relationships following palatoplasty for cleft lip and palate repair. J Dent Res;91(1): 47– 51. 2012.

11. Huddart AG and Bodenham RS. The evaluation of arch form and occlu-sion in unilateral cleft palate subjects. Cleft Palate J;9: 194–209. 1972.

12. Mossey PA, Clark JD, Gray D. Preliminary investigation of a modified Huddart/Bodenham scoring system for assessment of maxillary arch constriction in unilateral cleft lip and palate subjects. Eur J Orthod;25(3): 251–257. 2003.

13. Gray D and Mossey PA. Evaluation of a modified Huddart/Bodenham scoring system for assessment of maxillary arch constriction in unilateral cleft lip and palate subjects. Eur JOrthod; 27(5): 507–511. 2005.

14. Haque S, Alam MK, Arshad AI. An Overview of Indices Used to Measure Treatment Effectiveness in Patients with Cleft Lip and Palate. Malaysian J Med Sci;22(1): 4-11. 2015.

15. Alam MK, Iida J, Sato Y, Kajii TS. Postnatal treatment factors affecting craniofacial morphology of unilateral cleft lip and palate (UCLP) patients in a Japanese population. Br J Oral Maxillofac Surg;51(8):205-210. 2012.

16. Fudalej P, Katsaros C, Bongaarts C, Dudkiewicz Z, Kuijpers-Jagtman AM. Dental arch relationship in children with complete unilateral cleft lip and palate following one-stage and three-stage surgical protocol. Clin Oral Invest;15:503-510. 2011.

17. Fudalej P, Hortis-Dzierzbicka M, Obloj B, Miller-Drabikowska D Dudkiewicz Z, Romanowska A. Treatment outcome after one-stage repair in children with complete unilateral cleft lip and palate assessed with the Goslon Yardstick. Cleft Palate Craniofac J;46(4): 374-80. 2009.

18. Zaleckas L, Linkevicine L, Olekas J, Kutra N. The complication of different surgical techniques used for repair of complete unilateral cleft lip. Medicina (Kaunas);47: 85-90. 2011.

19. Sasaguri M, Hak MS, Nakamura N, Suzuki A, Sulaiman FK, Nakamura S, Ohishi M. Effects of Hotz’s palate and lip adhesion on maxillary arch in patients with complete unilateral cleft lip and palate until 5 years of age. J Oral MaxillofacSurg Med Patholog; 26: 292–300. 2014.

20. Koshikawa-Matsuno M, Kajii TS, Alam MK, Sugawara-Kato Y, Iida J. The effects of palatoplasty and pre-surgical infant orthopedic treatment on occlusion in unilateral cleft lip and palate patients. Orthod Waves;73(4): 114–120. 2014.

21. Atack N, Hathorn IS, Semb G, Dowell T, Sandy J. A new index for assessing surgical outcome in unilateral cleft lip and palate subjects aged five: Reproducibility and validity. Cleft Palate Craniofac J; 34(3):242- 246. 1997b.

22. Ferdous KMN, Ullah MS, Shajahan M, Mitul MAR, Islam MK, Das KK, Mannan MA, Rahman MJ, Biswas S, Salek AJM, Das BK. Simulta-neous Repair of Cleft Hard Palate by Vomer Flap along with Cleft Lip in Unilateral Complete Cleft Lip and Palate Patients. ISRN PlastSurg2013. doi:10.5402/2013/954576

23. Kajii TS, Alam MK, Milkoya T, Oyama A, Matsuno MK, Kato YS, Sato Y, Iida J. Congenital and postnatal factors including malocclusion in Japanese unilateral cleft lip and patient- determination using logistic regression analysis. Cleft Palate Craniofac J;50(4): 466–472. 2013.

24. Alam MK, Kajii TS, Matsuno MK, Kato YS, Iida J. Multivariate anal-ysis of factors affecting dental arch relationships in Japanese unilateral cleft lip and palate patients at Hokkaido University Hospital. Orthod Waves;67(2): 45–53. 2008.

25. Chan KT, Hayes C, Shusterman S, Mulliken JB, Will LA. The effects of active infant orthopsedics on occlusal relationships in unilateral complete cleft lip and palate. Cleft Palate Craniofac J;40(5): 511- 517. 2003.

26. Mars M, Asher-McDade C, Brattstrom V, Dahl E, McWilliam J, Mølsted K, Plint DA, Prahl-Andersen B, Semb G, Shaw WC, Ralph PS. A six-center international study of treatment outcome in patients with clefts of the lip and palate. Part 3. Dental arch relationships. Cleft Palate Craniofac J;29: 405–8. 1992.

27. Altman DG. Practical statistics for medical research. London: Chapman and Hall; 325–64, 404–8. 1991.

28. Altalibi M, Saltaji H, Edwards R, Major PW, Flores-Mir C. Indices to assess malocclusions in patients with cleft lip and palate. Euro J Orthod;35(6): 772–782. 2013.

29. Lilja J, Mars M, Elander A, Enocson L, Hagberg C, Worrell E, Batra P, Friede H. 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;43(5): 606–611. 2006.

30. Mossey PA, Little J, Munger RG, Dixon MJ, Shaw WC. Cleft lip and palate. Lancet;374(9703): 1773-85. 2009.

31. Paniagua LM, Martins Collares MV and Costa SS. Comparative study of three techniques of palatoplasty in patients with cleft of lip and palate via instrumental and auditory-perceptive evaluations. Int archives otorhino-laryngology;14(1):18-31. 2010.

32. Harila V, Ylikontiola LP, Sándor GK. Dental arch relationships assessed by GOSLON Yardstick in children with clefts in Northern Finland. Eur J Paediatr Dent;15(4): 389-391. 2014.

33. Dogan S, Semb G, Erbay E, Alcan T, Uzel A, Kocadereli I, Shaw WC. Dental arch relationships in Turkish patients with complete unilateral cleft lip and palate born between 1976 and 1990: a comparison with euro-cleft. Cleft Palate Craniofac J;51(1): 70-5. 2014.

34. Sinko K, Caacbay E, Jagsch R, Turhani D, Baumann A, Mars M. The GOSLON yardstickin patients with unilateral cleft lip and palate: review of a Vienna sample. Cleft Palate Craniofac J;45(1): 87-92. 2008.

35. Aposotol D. The Onizuka technique in treating the cleft lip and palate. Jurnal ul pediatrului;41-42. 200.

36. Meyer E and Seyfer A. Cleft lip repair: Technical refinements for the wide lips. Craniomaxillofac Trauma Reconstr;3(2): 81-6. 2010.

37. Agrawal K. Cleft palate repair and variations. Indian J Plast Surg;42(-Suppl): S102–S109. 2009.

38. Johnston CD, Leonard AG, Burden DJ, McSherry PF. A comparison of craniofacial form in Northern Irish children with unilateral cleft lip and palate treated with different primary surgical techniques. Cleft Palate Craniofac J ;41(1): 42-6. 2004.

39. Abdel-Aziz M and Ghandour H. Comparative study between V-Y push-back technique and Furlow technique in cleft soft palate repair. Eur J Plast Surg;34:27–32. 2011.

40. Jain H, Rao D, Sharma S and Gupta S. Assessment of Speech in Primary Cleft Palate by Two-layer Closure (Conservative Management). J Surg Tech Case Rep;4(1): 6–9. 2012.

41. Two-layer Closure (Conservative Management). J Surg Tech Case Rep;4(1): 6–9. 2012.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Scopus: CiteScore 1.8 (2023) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Submission Turnaround Time