Study of the Cephalometric Properties of Bite Anomalies in Sick Children with Heiloplasty
Keywords:
cleft lip and palate, cheiloplasty, cephalometry, malocclusion, maxillary deficiency, cone-beam computed tomography, maxillary protraction, early orthodontic treatmentAbstract
Background: Children with congenital cleft lip and palate frequently develop maxillary deficiency and malocclusion after cheiloplasty and palatoplasty, and cephalometric analysis is the main tool for diagnosing these changes and planning orthodontic treatment. Objective: To summarise current evidence on the cephalometric and three-dimensional characteristics of malocclusion in children and adolescents with repaired clefts and on the effectiveness of early orthodontic and orthopaedic treatment. Methods: A narrative review of comparative cephalometric, cone-beam computed tomography and clinical studies, systematic reviews and consensus documents was carried out; quantitative data were extracted from the original publications and presented in tables and figures. Results: Adolescents with cleft palate showed maxillary retrusion (SNA 77.70° versus 80.44°, p < 0.001), a reduced ANB angle (1.39° versus 3.34°, p < 0.001), a steeper palatal plane (NL–NSL 15.40° versus 8.52°) and posterior rotation of the mandible with a larger gonial angle, whereas SNB did not differ. Children with operated unilateral clefts had shorter faces, smaller mandibles and altered cranial base morphology, and CBCT revealed asymmetric buccolingual inclination of premolars on the cleft side. Bone-anchored maxillary protraction in 18 patients with unilateral clefts moved the maxilla forward by 1.5 mm and significantly increased SNA, ANB and the Wits appraisal compared with untreated controls. Meta-analytic evidence for early treatment in the general population is inconsistent. Conclusion: Malocclusion in children with repaired clefts has a predominantly maxillary, three-dimensional character, so orthodontic diagnosis should combine lateral cephalometry with CBCT, and early maxillary expansion and protraction should be planned individually within a multidisciplinary protocol.
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