Facial And Jaw Structures In Children Born With Cleft Lip And Palate: Effect Of The Timing And Protocol Of Surgery. A Narrative Review
Keywords:
cleft lip and palate, dental arch relationship, palatal morphology, maxillary growthAbstract
Background: In children with cleft lip and palate, the face and jaws develop with a congenital tissue deficiency, and primary surgery may influence later growth. Objective: To summarise current evidence on facial and maxillary anthropometry in children with clefts and on the effect of the timing and protocol of primary surgery on facial growth, dental arch relationship and palatal morphology. Methods: A narrative review of three-dimensional anthropometric, dental-cast, cephalometric and morphometric studies was carried out, and quantitative data were extracted from the original publications. Results: In a study of 252 digitised dental models of children operated at 3, 5–6 or 8–10 months, children with later lip repair showed better growth of the dental arches by the age of 5 years, and the Atack index of the earliest group differed significantly from the others (p < 0.0001). In 66 children with unilateral cleft lip and palate, a favourable dental arch relationship was associated with female sex (OR 6.08), delayed palate repair (OR 4.77) and neonatal plates (OR 4.68), and a favourable palatal morphology with delayed palate repair (OR 9.76). A three-centre study found the palatal shape after one-stage repair closest to that of controls and after palatoplasty at about 36 months most deviant. Conclusion: Facial and maxillary growth after cleft surgery depends on the timing and protocol of surgery as well as on intrinsic factors; outcome data are partly contradictory, and surgical protocols should be evaluated with standardised three-dimensional and dental-arch indices.
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