Vomer flap for hard palate repair is related to favorable maxillary growth in unilateral cleft lip and palate

Objective: To analyze published papers dealing with delayed hard palate repair within a two-stage palatal surgery protocol in treatment of cleft lip and palate. Timing of the procedures, methods used, as well as growth results were considered. Method: By utilizing this information in relation to knowledge about normal maxillary development, efforts were made to explain differences in growth outcome between different investigations. Particularly, follow-up reports of unilateral cleft lip and palate patients with records up to at least 10 years of age were studied. Results: Most papers reported an excellent or very good maxillary growth outcome after their delayed hard palate closure protocols. Where unsatisfactory results were published, reasonable explanations were found accounting for why the method had failed the expectation of good maxillary growth. Conclusion: Based on the published reports and the experience from a cleft team where the studied protocol has been practiced since 1975, recommendation for method as well as timing for the two-stage protocol is laid out in some detail.

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Hard Palate Repair Timing and Facial Growth in Unilateral Cleft Lip and Palate: A Longitudinal Study

The Cleft Palate-Craniofacial Journal ◽

10.1597/05-119 ◽

2006 ◽

Vol 43 (5) ◽

pp. 547-556 ◽

Cited By ~ 53

Author(s):

Yu-Fang Liao ◽

Timothy J. Cole ◽

Michael Mars

Keyword(s):

Longitudinal Study ◽

Hard Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Sri Lankan ◽

Facial Morphology ◽

Facial Growth ◽

Clinical Notes ◽

Timing Effect ◽

Palate Repair

Objective: To investigate whether timing of hard palate repair had a significant effect on facial growth in patients with unilateral cleft lip and palate (UCLP). Design: Retrospective longitudinal study. Setting: Sri Lankan Cleft Lip and Palate Project. Patients: A total of 104 patients with nonsyndromic UCLP who had hard palate repair by age 13 years, with their 290 cephalometric radiographs taken after lip and palate repair. Main Outcome Measures: Clinical notes were used to record surgical treatment histories. Cephalometry was used to determine facial morphology and growth rate. Results: Timing of hard palate repair had a significant effect on the length and protrusion of the alveolar maxilla (PMP-A and SNA, respectively) and the anteroposterior alveolar jaw relation (ANB) at age 20 years but not on their growth rates. Conclusion: Timing of hard palate repair significantly affects the growth of the maxilla in patients with UCLP. Late hard palate repair has a smaller adverse effect than does early hard palate repair on the growth of the maxilla. This timing effect primarily affects the anteroposterior development of the maxillary dentoalveolus and is attributed to the development being undisturbed before closure of the hard palate.

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Palatal morphology in unilateral cleft lip and palate patients: Association with infant cleft dimensions and timing of hard palate repair

Orthodontics and Craniofacial Research ◽

10.1111/ocr.12318 ◽

2019 ◽

Vol 22 (4) ◽

pp. 270-280 ◽

Cited By ~ 1

Author(s):

Susanna Botticelli ◽

Annelise Küseler ◽

Kirsten Mølsted ◽

Maja Ovsenik ◽

Sven Erik Nørholt ◽

...

Keyword(s):

Hard Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Palate Repair

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Influence of Infant Cleft Dimensions on Velopharyngeal Function in 5-Year-Old Danish Children Born With Unilateral Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665619874143 ◽

2019 ◽

Vol 57 (4) ◽

pp. 420-429

Author(s):

Susanna Botticelli ◽

Annelise Küseler ◽

Kirsten Mølsted ◽

Helene Soegaard Andersen ◽

Maria Boers ◽

...

Keyword(s):

Soft Palate ◽

Hard Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Controlled Trial ◽

Velopharyngeal Insufficiency ◽

Primary Surgery ◽

Multicenter Randomized Controlled Trial ◽

Palate Repair ◽

Velopharyngeal Function

Aim: To examine the association of cleft severity at infancy and velopharyngeal competence in preschool children with unilateral cleft lip and palate operated with early or delayed hard palate repair. Design: Subgroup analysis within a multicenter randomized controlled trial of primary surgery (Scandcleft). Setting: Tertiary health care. One surgical center. Patients and Methods: One hundred twenty-five infants received cheilo-rhinoplasty and soft palate repair at age 3 to 4 months and were randomized to hard palate closure at age 12 or 36 months. Cleft size and cleft morphology were measured 3 dimensionally on digital models, obtained by laser surface scanning of preoperative plaster models (mean age: 1.8 months). Main outcome measurements: Velopharyngeal competence (VPC) and hypernasality assessed from a naming test (VPC-Sum) and connected speech (VPC-Rate). In both scales, higher scores indicated a more severe velopharyngeal insufficiency. Results: No difference between surgical groups was shown. A low positive correlation was found between posterior cleft width and VPC-Rate (Spearman = .23; P = .025). The role of the covariate “cleft size at tuberosity level” was confirmed in an ordinal logistic regression model (odds ratio [OR] = 1.17; 95% confidence interval [CI]:1.01-1.35). A low negative correlation was shown between anteroposterior palatal length and VPC-Sum (Spearman = −.27; P = .004) and confirmed by the pooled scores VPC-Pooled (OR = 0.82; 95% CI: 0.69-0.98) and VPC-Dichotomic (OR = 0.82; 95% CI: 0.68-0.99). Conclusions: Posterior cleft dimensions can be a modest indicator for the prognosis of velopharyngeal function at age 5 years, when the soft palate is closed first, independently on the timing of hard palate repair. Antero-posterior palatal length seems to protect from velopharyngeal insufficiency and hypernasality. However, the association found was significant but low.

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A Comparison of Three Methods of Repairing the Hard Palate

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_2002_039_0383_acotmo_2.0.co_2 ◽

2002 ◽

Vol 39 (4) ◽

pp. 383-391 ◽

Cited By ~ 20

Author(s):

R. W. Pigott ◽

E. H. Albery ◽

I. S. Hathorn ◽

N. E. Atack ◽

A. Williams ◽

...

Keyword(s):

Hard Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Small Sample Size ◽

Statistical Significance ◽

Small Sample ◽

Velopharyngeal Insufficiency ◽

Strong Trend ◽

Computer Based ◽

Palate Repair

Objective To compare growth, speech, and nasal symmetry outcomes of three methods of hard palate repair. Patients Consecutive available records of children born with unilateral bony complete cleft lip and palate over the period 1972 to 1992. Interventions Identical management of lip, nose, alveolus, and soft palate. Hard palate repair by Cuthbert Veau (CV) from 1972 to 1981, von Langenbeck (vL) from 1982 to 1989, or medial Langenbeck (ML) from 1989 to 1991. Outcome Measures For growth: GOSLON yardstick or 5-year model index. For speech: articulation test. Nasal anemometry. For nasal symmetry: Coghlan computer-based assessment. All these measures were developed during the period of data collection but not for this project. Results There was a strong trend toward more favorable anteroposterior maxillary growth with the change from CV to vL to ML techniques. This fell short of statistical significance because of the small sample size. There was a significant reduction in cleft-related articulation faults (p = .01) considered to be related to improved arch form. In the absence of improved rates of velopharyngeal insufficiency or nasal symmetry, increased surgical experience was discounted as a significant contribution to improved growth and articulation outcomes. Conclusions Reduced periosteal undermining and residual exposed palatal shelf from CV to vL to ML improved incisor relationships and articulation.

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Hard Palate Repair Timing and Facial Growth in Cleft Lip and Palate: A Systematic Review

The Cleft Palate-Craniofacial Journal ◽

10.1597/05-058 ◽

2006 ◽

Vol 43 (5) ◽

pp. 563-570 ◽

Cited By ~ 48

Author(s):

Yu-Fang Liao ◽

Michael Mars

Keyword(s):

Systematic Review ◽

Hard Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Case Reports ◽

Case Series ◽

Long Term Results ◽

Facial Growth ◽

Cleft Lip Palate ◽

Palate Repair

Objective: To evaluate the effect of timing of hard palate repair on facial growth in patients with cleft lip and palate, with special reference to cranial base, maxilla, mandible, jaw relation, and incisor relation. Design: A systematic review. Methods: The search strategy was based on the key words “facial growth,” “cleft lip palate,” and “timing of (hard) palate repair.” Case reports, case-series, and studies with no control or comparison group in the sample were excluded. Results: Fifteen studies met the selection criteria. All the studies were retrospective and nonrandomized. Five studies used cephalometry and casts, seven used cephalometry, and three used casts. Methodological deficiencies and heterogeneity of the studies prevented major conclusions. Conclusion: The review highlights the importance of further research. Prospective well-designed, controlled studies, especially targeting long-term results, are required to elucidate the effect of timing of hard palate repair on facial growth in patients with cleft lip and palate.

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