Abstract
BackgroundCleft lip and palate (CLP) is one of the most common birth defects. Multiple factors are believed to be responsible for an unfavorable dental arch relationship in CLP. Facial growth (maxillary) retardation, which results in class III malocclusion, is the primary challenge that CLP patients face. Phenotype factors and postnatal treatment factors influence treatment outcomes in unilateral cleft lip and palate (UCLP) children, which has led to a great diversity in protocols and surgical techniques by various cleft groups worldwide. The aim of this study was to illustrate the dental arch relationship (DAR) and palatal morphology (PM) of UCLP in Bangladeshi children and to explore the various factors that are responsible for poor DAR and PM.MethodsDental models of 84 subjects were taken before orthodontic treatment and alveolar bone grafting. The mean age was 7.69 (SD 2.46) years. The DAR and PM were assessed blindly by five raters using the EUROCRAN index (EI). Kappa statistics was used to evaluate the intra- and inter-examiner agreement, chi square was used to assess the associations, and logistic regression analysis was used to explore the responsible factors that affect DAR and PM.ResultsThe mean EUROCRAN scores were 2.44 and 1.93 for DAR and PM, respectively. Intra- and inter-examiner agreement was moderate to very good. Using crude and stepwise backward regression analyses, significant associations were found between the modified Millard technique (P = 0.047, P = 0.034 respectively) of cheiloplasty and unfavorable DAR. Complete UCLP (P = 0.017) was also significantly correlated with unfavorable DAR. The PM showed a significant association with the type of cleft, type of cheiloplasty and type of palatoplasty.ConclusionThis multivariate study determined that the complete type of UCLP and the modified Millard technique of cheiloplasty had significantly unfavorable effects on both the DAR and PM.
Highlights
Cleft lip and palate (CLP) is one of the most common birth defects
Treatment outcomes for unilateral cleft lip and palate (UCLP) patients can be evaluated by various indices, such as the GOSLON Yardstick [12], the 5-year-old index [10], the GOAL index [25],the EUROCRAN index [7],the Huddart Bodenham scoring system [26],and the modified Huddart Bodenham scoring system [13, 14]
We evaluated the dental arch relationship (DAR) based on various congenital/phenotype factors and postnatal treatment factors that are responsible for poor DAR and palatal morphology (PM)
Summary
Cleft lip and palate (CLP) is one of the most common birth defects. Multiple factors are believed to be responsible for an unfavorable dental arch relationship in CLP. Phenotype factors and postnatal treatment factors influence treatment outcomes in unilateral cleft lip and palate (UCLP) children, which has led to a great diversity in protocols and surgical techniques by various cleft groups worldwide. Cleft lip and palate (CLP) is one the most common congenital anomalies present at birth and is caused by the failure of the palatal shelves to fuse during the embryonic stage [1] Both congenital (genetic) and environmental factors are thought to be responsible for this malformation [2,3,4]. A lack of consideration of factors affecting the outcome of treatment in children with CLP has led to great diversity in protocols and surgical techniques by various cleft groups worldwide [9]. To ensure the success of the treatment, methods need to be based on sound evidence so that a surgeon can modify their timing or techniques if needed [10]
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