Bilateral cleft lip and palate: improved maxillary and dental development.

Abstract

Maxillary growth deficiency is still a problem in children with repaired cleft lip-cleft palate, and little progress has been made on research for its prevention. An increase in the early diagnosis of maxillary growth deficiency prompted this study to obtain an early indication of the efficacy of a new protocol for better dental and maxillary development. A new method for repair of the hard palate in infants with bilateral cleft lip-cleft palate that made innovative use of mucosa of the nasal septum and involved less extensive surgery was coupled with the repair of the lip at 18 months instead of at 8 months. Twelve consecutive cases were compared with 12 cases treated by the previous method. Records of dental occlusion and lateral head radiographs at 5 years were obtained prospectively for the new treatment group and retrospectively for the previous group. In the previous group, there was a high incidence of dental crossbite. Incisor crossbite was present in 10 of the 12 (83 percent), and all 12 had one or both cuspids in crossbite. In the new treatment group, the incisor crossbite was reduced to four of 12 cases (33 percent), with cuspid crossbite at 50 percent. The new treatment group also showed greater values for cephalometric measures in maxillary length, maxillary prominence, and the ANB angle. At the age of 5 years, a definite improvement in dental and maxillary development was evident in the new treatment group.