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Cleft Size and Maxillary Arch Dimensions in Unilateral Cleft Lip and Palate and Cleft Palate
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The wide variation in infant maxillary morphology and cleft size of children with unilateral cleft lip and palate (UCLP) and isolated cleft palate (CP) raise concerns about their possible influences on treatment outcome. The studies in this thesis aimed to investigate the relation between cleft size in infancy and crossbite at 5 years of age (Paper I); the impact of primary surgery on cleft size and maxillary arch dimensions from infancy to 5 years of age (Paper II); associations between cleft size, maxillary arch dimensions and facial growth in both UCLP and CP children (Paper III); and, to evaluate the relation between infant cleft size and nasal airway size and function in adults treated for UCLP (Paper IV).

In homogenously treated groups of children with UCLP and CP, dental casts were used to measure cleft size and maxillary arch dimensions from infancy up to 5 years of age, and for crossbite recording at 5 years. Serial lateral cephalometric radiographs taken between 5 and 19 years of age in the same groups were used to study facial growth. Nasal airway size and function were evaluated by acoustic rhinometry, rhinomanometry, peak nasal inspiratory flow and odour test in a group of adults treated for UCLP.

The main findings were: crossbite was a frequent malocclusion at 5 years of age in children with UCLP and large cleft widths at the level of the cuspid points in infancy were associated with less anterior and posterior crossbite in this group (Paper I). Cleft widths decreased after lip closure and/or soft palate closure in both UCLP and CP children. Initially, UCLP children had wider maxillary arch dimensions, but after hard palate closure, the transverse growth was reduced, and at 5 years, they had smaller maxillary arch widths than CP children had (Paper II). Maxillary arch depths and cleft widths in infancy were correlated with maxillary protrusion and sagittal jaw relationships in both UCLP and CP children (Paper III), but cleft width in infancy was not correlated with nasal airway size and function in adults treated for UCLP (Paper IV).

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2011. , p. 74
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 722
Keyword [en]
Unilateral cleft lip and palate, cleft palate, cleft size, maxillary arch dimensions, crossbite, facial growth, nasal function
National Category
Dentistry
Research subject
Oral and Maxillofacial Surgery
Identifiers
URN: urn:nbn:se:uu:diva-160178ISBN: 978-91-554-8213-8 (print)OAI: oai:DiVA.org:uu-160178DiVA: diva2:451480
Public defence
2011-12-09, Skoogsalen, Uppsala University Hospital, entrance 79, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2011-11-18 Created: 2011-10-17 Last updated: 2011-11-23Bibliographically approved
List of papers
1. Association Between Cleft Size and Crossbite in Children With Cleft Palate and Unilateral Cleft Lip and Palate
Open this publication in new window or tab >>Association Between Cleft Size and Crossbite in Children With Cleft Palate and Unilateral Cleft Lip and Palate
2010 (English)In: The Cleft Palate-Craniofacial Journal, ISSN 1055-6656, E-ISSN 1545-1569, Vol. 47, no 2, p. 175-181Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate the association between cleft size in infancy and crossbite at 5 years of age in children with cleft palate (CP) and unilateral cleft lip and palate (UCLP). Design: Retrospective study. Setting: University Hospital, Uppsala, Sweden. Patients: Dental study models of 80 consecutive children, 51 children with CP and 29 children with UCLP, born between 1990 and 1999 were analyzed. Interventions: Lip repair at 3 to 4 months in UCLP children. Primary soft palate repair at 6 to 10 months and secondary hard palate closure at 25 to 26 months of age. Main Outcome Measures: Maxillary arch dimensions and cleft size were measured on infancy dental casts. At follow-up at 5 years, crossbite scores were registered on dental study models. Results: The cleft dimensions in infancy showed large interindividual variation. Mean posterior cleft width was larger in UCLP children than in children with CP. The UCLP group also had significantly more crossbite at 5 years than the CP group. No significant association was noted between initial cleft size and crossbite scores at 5 years in the CP group. For the UCLP group, larger cleft widths at the level of the cuspid points were significantly associated with less anterior and posterior crossbite. Conclusions: The findings support the hypothesis that cleft size in infancy affects early outcome with respect to crossbite in children with UCLP, but not in children with CP.

Keyword
cleft lip and palate, cleft size, crossbite, primary dentition and two-stage palatal repair
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-136667 (URN)10.1597/08-219.1 (DOI)000276023900010 ()
Available from: 2010-12-14 Created: 2010-12-14 Last updated: 2017-12-11Bibliographically approved
2. Early dimensional changes in maxillary cleft size and arch dimensions of children with cleft lip and palate and cleft palate
Open this publication in new window or tab >>Early dimensional changes in maxillary cleft size and arch dimensions of children with cleft lip and palate and cleft palate
2013 (English)In: The Cleft Palate-Craniofacial Journal, ISSN 1055-6656, E-ISSN 1545-1569, Vol. 50, no 4, p. 481-490Article in journal (Refereed) Published
Abstract [en]

Objective: To study changes in cleft size and maxillary arch dimensions from infancy to 5 years and evaluate these changes in relation to performed surgical procedures.

Design: Retrospective longitudinal study.

Setting:  The Cleft Lip and Palate Centre, Uppsala University Hospital, Sweden.

Patients: Dental study models of 79 consecutive children, 28 with unilateral cleft lip and palate (UCLP), 39 with cleft palate (CP) and 12 with Pierre Robin Sequence (PRS) were analyzed.

Interventions: Lip repair at 3-4 months, soft palate repair at 6-10 months and hard palate repair at 25-26 months of age.

Main Outcome Measures: Cleft size was measured before each surgical intervention up to 2 years and arch dimensions were measured before each surgical intervention and at 5 years.

Results: Cleft widths decreased from infancy up to 2 years, but the antero-posterior cleft length in CP was unchanged. Arch widths at C-C1and T-T1 and also the change over time in C-C1 and T-T1 differed significantly between the groups from infancy up to 5 years. 

Conclusions: Cleft widths decreased after lip closure and/or soft palate closure. The UCLP children had wider maxillary arch dimensions than the CP and PRS children during the first years of life, but after hard palate closure the transverse growth was reduced in the UCLP children. At 5 years the UCLP children had smaller maxillary widths than the CP and PRS children especially at the level of the cuspids.

Keyword
unilateral cleft lip and palate, cleft palate, cleft size, maxillary arch dimensions
National Category
Dentistry
Research subject
Oral and Maxillofacial Surgery
Identifiers
urn:nbn:se:uu:diva-160176 (URN)10.1597/11-003 (DOI)000327535400016 ()22122198 (PubMedID)
Available from: 2011-10-17 Created: 2011-10-17 Last updated: 2017-12-08Bibliographically approved
3. Facial growth in unilateral cleft Lip and palate and cleft palate: associations with maxillary dimensions and cleft size in infancy
Open this publication in new window or tab >>Facial growth in unilateral cleft Lip and palate and cleft palate: associations with maxillary dimensions and cleft size in infancy
2011 (English)Article in journal (Refereed) Submitted
Abstract [en]

Objective: To study facial growth from 5 to 19 years of age and the correlation with maxillary arch dimensions and cleft size in infancy in children with unilateral cleft lip and palate (UCLP) and cleft palate (CP).

Design: Retrospective longitudinal study.

Setting:  The Cleft Palate Centre, Uppsala University Hospital, Sweden.

Patients:  Thirty-three consecutive patients with UCLP, 64 with CP (51 with cleft palate only (CPo) and 13 with Pierre Robin Sequence (PRS)) were included in the study. 

Interventions: Lip repair at 3-4 months in UCLP children. Soft palate repair at 6-7 months and hard palate repair at 2 years in UCLP and CP. Secondary bone grafting at 9 years of age in UCLP.

Main Outcome Measures: Maxillary arch dimensions and cleft size were measured on dental casts taken in infancy. Cephalometrics was used to study facial growth from 5 to 19 years of age.

Results: Maxillary arch depths showed positive correlations to SNA and ANB. Cleft width in infancy was negatively correlated to SNA, ANB and NSBa. The growth rates for SNA and ANB were significantly more negative for the UCLP group compared to the CPo group.

Conclusions: Maxillary arch depths and cleft widths in infancy were associated with maxillary protrusion and sagittal jaw relationships during growth in both UCLP and CP children. Maxillary protrusion and sagittal jaw relation developed less favourably in UCLP compared to CPo.

Keyword
Unilateral cleft lip and palate, cleft palate, cleft size, maxillary arch dimensions, facial growth
National Category
Dentistry
Research subject
Oral and Maxillofacial Surgery
Identifiers
urn:nbn:se:uu:diva-160177 (URN)
Available from: 2011-10-17 Created: 2011-10-17 Last updated: 2011-11-23Bibliographically approved
4. Initial size of cleft does not correlate with size and function of nasal airway in adults with unilateral cleft lip and palate
Open this publication in new window or tab >>Initial size of cleft does not correlate with size and function of nasal airway in adults with unilateral cleft lip and palate
2011 (English)In: Journal of plastic surgery and hand surgery, ISSN 2000-656X, Vol. 45, no 3, p. 129-135Article in journal (Refereed) Published
Abstract [en]

The noses of patients with clefts are often functionally inadequate. The aim of the present study was to evaluate the correlation between size of the maxillary cleft in infancy and size and function of the nasal airway in adults with unilateral cleft lip and palate (UCLP). This is a long-term follow up study including 53 patients with UCLP born between 1960 and 1987 and treated at the Cleft Lip and Palate Centre, Uppsala University Hospital, Sweden. Lip repair was performed at 3--4 months of age followed by either a one-stage or a two-stage palatal closure. The size of the cleft was measured on infant maxillary dental casts. Nasal minimum cross-sectional area (cm<SU2</SU) and volume (cm<SU3</SU) (acoustic rhinometry), air flow resistance (Pa s/cm<SU3</SU) (rhinomanometry), peak inspiratory flow (l/min) (peak nasal inspiratory flow) and number of identified odours (Scandinavian odor-identification test) were assessed in adulthood. The size of the maxillary cleft varied considerably at infancy. The size of the nasal airway and its function on the cleft side in adulthood were reduced compared with the non-cleft side, but no correlations were found between size of the initial cleft in infancy and size and function of the nasal airway in adulthood. In adults born with UCLP, therefore, size of the maxillary cleft in infancy does not seem to affect size and function of the nasal airway in adulthood.

Keyword
Unilateral cleft lip and palate, cleft size, acoustic rhinometry, rhinomanometry, nasal resistance, odour identification
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-155931 (URN)10.3109/2000656X.2011.576839 (DOI)000291815000002 ()
Available from: 2011-07-04 Created: 2011-07-04 Last updated: 2011-11-23Bibliographically approved

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