Effect of different timing of hard palate closure on maxillary growth in patients with cleft lip, alveolus and palate.

Abstract

Timing of hard palate closure (HPC) in patients with cleft lip, alveolus, and palate (CLAP) varies and remains controversial. This study evaluates maxillary outgrowth after delayed HPC. A retrospective cohort study of patients with CLAP born between 1994-2000 who underwent HPC between the age of 9 to 12 years synchronous with secondary alveolar repair. The primary outcome was anteroposterior maxillary growth at skeletal maturity. Secondary outcomes were anteroposterior mandibular growth, incidence of Le Fort I osteotomy (LF I), and the impact of velopharyngoplasty on maxillary growth. Lateral cephalograms were analysed at the ages of 6, 9, and 17 years. The SNA, SNB, and ANB angles were digitally traced. These were compared to those of previously published studies on a cohort of patients who underwent early HPC at the age of 12 months and on the facial growth of unaffected individuals. The study sample comprised 133 patients. HPC was performed at a mean age of 10,3 years. Maxillary hypoplasia was seen in unilateral and bilateral group. Forty-nine (36,8%) patients underwent velopharyngoplasty. LF I osteotomy was performed in 18 patients (13.5 %). No difference was seen in SNA (p 0,464) and SNB (p = 0.505) angles between our results after delayed HPC and early HPC. Significant differences in SNA (p = 0.001) and SNB (p = 0.002) angles were found when comparing with data of unaffected individuals. Comparable maxillary growth was found in patients with unilateral CLAP after delayed and early HPC. Velopharyngoplasty did not influence maxillary growth.