Unilateral complete cleft lip and palate repair using lip adhesion combined with a passive intraoral alveolar molding appliance: surgical results and the effect on the maxillary alveolar arch.

Abstract

A number of combined maxillary orthopedic and surgical treatment protocols have been proposed for the initial phase of therapy for infants with a complete cleft lip and palate. Lip adhesion was used in combination with a passive intraoral molding appliance to treat a unilateral complete cleft lip and palate. The proposed protocols are lip adhesion, along with positioning of a passive alveolar molding appliance, at 4 to 6 weeks of age, then definitive cheiloplasty at 4 to 5 months of age, and palatoplasty at 12 months of age. Twenty-five patients with a complete cleft lip and palate were treated using this protocol between 1994 and 2003. The follow-up period was between 6 months and 10 years. The alveolar gap, the length of the maxillary alveolar cleft, and the palatal gap were 10.1 +/- 4.2 mm, 6.1 +/- 0.9 mm, and 13.4 +/- 2.9 mm for lip adhesion, 3.1 +/- 1.4 mm, 2.6 +/- 0.8 mm, and 9.6 +/- 1.5 mm for definitive cheiloplasty, and 0.2 +/- 0.1 mm, 1.5 +/- 0.7 mm, and 8.3 +/- 1.1 mm for palatoplasty. For the following maxillary dental casts for 3 to 10 year olds, the intercanine width and canine arch lengths were within the normal value. The intermolar width and the molar arch length, however, decreased slightly compared with the control normal values. Lip adhesion and a passive alveolar molding appliance achieved a normal position and stabilized the arch in a symmetrical platform.