Two-stage cleft palate closure by our treatment algorithm in complete unilateral cleft lip and palate: Results of maxillary growth at 6 years of age

Abstract

ObjectiveWe evaluated maxillary growth outcomes of our modification of a two-stage palatoplasty algorithm (the Zurich University protocol) for the treatment of complete unilateral cleft lip, alveolus, and palate (UCLP) that allows for maxillary growth by delaying alveolar and hard palate closure with bone grafting until age 8 years or older. MethodsWe obtained measurements from lateral cephalograms taken at age 6 years for 46 consecutive patients and compared them between the two-stage group and children without UCLP (non-cleft group) and children with UCLP historically treated with push-back palatoplasty. Values related to facial growth were compared between the three groups and by sex. Profilograms were compared between the two-stage and non-cleft groups. ResultsSella-nasion distance, sella-nasion-point A angle, and sella-nasion-point B angle were significantly smaller in the two-stage group than in the non-cleft group among boys but were not significantly different among girls. Profilograms showed that these smaller values reflected a smaller skull size. However, in the two-stage group, the point A-nasion-point B angle (∠ANB) was 2 standard deviations (SDs) less than the mean in 3 patients (6.5%) and 1 SD less in 10 patients (21.7%), reflecting poor maxilla-mandibular relationships. Compared with the push-back group, the two-stage group showed better maxillary growth in all measured values. ConclusionsPostoperative maxillary growth was acceptable and better with two-stage palatoplasty than with push-back palatoplasty. However, about 30% of two-stage patients had worse ∠ANB, indicating the need for careful follow-up and analysis of maxillary growth when the child reaches adulthood.