Complete Cleft Palate Research Articles

My Drug-Free VBAC During Covid.

In 2016, I had a complicated cesarean. My daughter was breech and I ended up with a crash cesarean resulting in internal organ damage; furthermore, she was born with a complete cleft lip and palate, so breastfeeding was not possible. In spring 2020, as the world was locking down for Covid, I found out I was having a baby boy, due in September. I wanted to try for a VBAC (vaginal birth after cesarean) to reduce my risk of complications and to heal emotionally from the complicated cesarean. My OB-GYN advised me to stay home as long as possible, as my designated hospital was not known for encouraging VBACs. I woke up on August 29 at 4:30am, 2 weeks before my due date, having mild contractions. I ate, read a book, and timed my contractions and tried to be quiet so as not to wake anyone up. By 6:30am, the contractions were strong so I woke up my husband and we dropped our two girls off with a family friend. We dropped them off at 7:20 and raced to the hospital. Luckily the hospital was only 2 miles away. I showed up fully dilated and ready to push. I would have had my son in the parking lot if a bystander hadn't brought a wheelchair. I had to sign a consent paper and do the rapid Covid test after delivering my son. It was an incredibly healing birth.

Comparative Investigation of the Influence of One-stage Palatoplasty and Two-stage Palatoplasty on Tooth and Dental Arch Forms in Patients with Unilateral Complete Cleft Lip and Palate

Comparative Investigation of the Influence of One-stage Palatoplasty and Two-stage Palatoplasty on Tooth and Dental Arch Forms in Patients with Unilateral Complete Cleft Lip and Palate

Three-dimensional evaluation of soft tissue changes following bone-anchored maxillary protraction protocol in patients with complete unilateral cleft lip and palate

Three-dimensional evaluation of soft tissue changes following bone-anchored maxillary protraction protocol in patients with complete unilateral cleft lip and palate

Changes in nasal symmetry after presurgical nasoalveolar molding in infants treated with complete unilateral cleft lip and palate: A follow-up study

Changes in nasal symmetry after presurgical nasoalveolar molding in infants treated with complete unilateral cleft lip and palate: A follow-up study

Corrective Rhinoplasty Using Rib Cartilage for Patients with Unilateral Complete Cleft Lip and Palate

Corrective Rhinoplasty Using Rib Cartilage for Patients with Unilateral Complete Cleft Lip and Palate

Long-term follow-up of mandibular dental arch changes in patients with complete non-syndromic unilateral cleft lip, alveolus, and palate.

BackgroundTreatment of cleft lip and palate (CLP) requires a comprehensive interdisciplinary approach and long-term follow-up. Only a few studies are available that reported on changes after treatment, which showed that in particular the transverse dimension, in patients with CLP is prone to changes after treatment. However, those studies did not pay attention to concomitant changes in the mandibular arch that occur after treatment.ObjectivesTo evaluate mandibular transverse dental arch dimensions and interarch transverse changes in patients with complete non-syndromic unilateral cleft lip, alveolus, and palate (CUCLAP) up to five years after treatment.Material and MethodsRetrospective longitudinal study in 75 consecutive patients with CUCLAP directly after comprehensive treatment (T0), two (T2), and 5 years after treatment (T5). Great Ormond Street, London and Oslo (GOSLON) scores were available for all patients. Three-dimensional scans of all dental casts were made. Inter premolar and intermolar distances between the mandibular contralateral teeth were measured. The modified Huddart Bodenham (MHB index) was applied to assess the transverse interarch relationship. Paired t-tests and ANOVA were used to analyze transverse and interarch transverse changes. Linear regression analysis was done to define contributing factors.ResultsPaired t-tests showed a significant decrease of the mandibular inter first and second premolar distances (p < 0.05) and an increase of the inter second molar distance, whilst the MHB Index deteriorated at all time points for all segments and for the total arch score (p < 0.05). Linear regression showed no significant contributing factors on the decrease of the transverse distances. However, inter arch transverse relationship was significantly affected by age at the end of treatment, missing maxillary lateral incisor space closure, and the GOSLON Yardstick score at the end of treatment (p < 0.05), especially during the first two years after treatment.ConclusionsChanges occurred in the mandibular arch expressed as changes in the transverse dimensions and interarch relationship measured by the MHB Index. A younger age at the end of treatment, space closure for a missing maxillary lateral incisor and a higher GOSLON score at the end of treatment negatively influence the interarch transverse deterioration especially in the first two years after treatment. For the transverse dimensional changes in the mandibular arch such influencing factors could not be determined.

Comparison of Preoperative Measurement Methods of Alveolar Cleft Volume Using Cone Beam Computed Tomography between Computer Simulation and Water Displacement Methods.

To compare the use of a computer simulation by Mimics software and the water displacement method as means for measurement of alveolar cleft volume on cone beam computed tomography (CBCT) data. Prospective study. Institutional research. Patients with unilateral complete cleft lip and palate (UCCLP) who would undergo alveolar bone grafting. CBCT images of twenty patients with UCCLP were included in the study. In the first method, the water displacement method was adopted to measure volume of plasticine filled in the alveolar cleft imprinted on 3D printed model of maxilla. In the second method a volumetric assessment function in Mimics software was adopted to measure volume of 3D virtual model of alveolar cleft constructed from CBCT images. A comparison on the alveolar cleft volumes derived from the two methods was assessed using the statistical paired t-test. The paired-t test showed no statistically significant difference between alveolar cleft volumes measured by the two methods (P = 0.075). Mean volume of the alveolar cleft measured by the water displacement method was 1.03 ± 0.31 ml whereas by the computer simulation using Mimics software the value was 1.00 ± 0.31 ml. The mean difference between the two methods was 0.03 ± 0.08 ml. The computer simulation by Mimics software as a means for measurement of alveolar cleft volume on CBCT data is as accurate as the measurement by the water displacement method.

Gingivosupraperiosteoplasty following Presurgical Maxillary Orthopedics Is Associated with Normal Midface Growth in Complete Unilateral and Bilateral Cleft Patients at Mixed Dentition.

Passive orthodontic appliances and gingivosupraperiosteoplasty are adjuncts that can be used by surgeons at the time of primary cleft lip repair. These treatments, along with the surgical technique of cleft lip and palate repair, may impact midface growth. The objective of this study was to describe the authors' protocol for unilateral and bilateral cleft lip repair and to evaluate midfacial growth in a cohort of patients at mixed dentition who had undergone presurgical passive orthodontic appliance therapy and gingivosupraperiosteoplasty at the time of unilateral and bilateral cleft lip repair. Fifteen complete unilateral and 15 complete bilateral cleft lip and palate patients underwent passive orthodontic appliance treatment and primary lip repair with gingivosupraperiosteoplasty. Lateral cephalograms were analyzed by three blinded reviewers. Mean cephalometric measurements at mixed dentition were compared to cephalometric values for noncleft patients, unilateral cleft lip and palate patients who did not undergo gingivoperiosteoplasty or presurgical treatment, and unilateral cleft lip and palate patients who underwent gingivoperiosteoplasty/nasoalveolar molding with independent samples t tests. Mean cephalometric values were within age-specific normal values for sella-nasion-A point, sella-nasion-B point, A point-nasion-B point, and facial axis. Eighty-seven (13/15) percent of unilateral cleft lip and palate patients and 93 percent (14/15) of bilateral cleft lip and palate patients did not exhibit skeletal class III malocclusion. There was no significant difference between cephalometric values for our patients and patients who did not receive gingivosupraperiosteoplasty or presurgical treatment or who underwent the gingivoperiosteoplasty/nasoalveolar molding protocol. Presurgical passive orthodontic appliances, combined with gingivosupraperiosteoplasty at the time of lip repair, leads to normal maxillary development in most patients at mixed dentition. Assessment of midface growth at skeletal maturity is required. Therapeutic, IV.

Arhinia and Bilateral Anophthalmia: Report of a Rare Case and Review of Literature

Arhinia is an extremely rare condition reported in less than 100 cases so far. We report a case of arhinia with bilateral anophthalmia. In physical examination, only alar portions of the nose were partially formed. No septal, lower, upper lateral cartilages or nasal bones were detectable. Both nostrils were atretic. The orbital area was covered with skin, and eyebrows were partially formed. Bilateral complete cleft lip and palate were evident. Surgical interventions should be considered not only for reconstruction of the external nose but for timely creation of a lacrimal passage and repair of the accompanying cleft lip and palate.

Nasal molding prevents relapse of nasal deformity after primary rhinoplasty in patients with unilateral complete cleft lip: An outcomes-based comparative study of palatal plate alone versus nasoalveolar molding.

ObjectivesIn recent years, many studies have reported that the presurgical nasoalveolar molding method improves the nose morphology; however, the reason for its effectiveness after surgery has never been understood. We evaluated the effect of nasoalveolar molding by comparing it with a passive orthopedic method without a nasal stent and focusing on the nostril morphology after primary cheiloplasty using various measurement methods. We then analyzed the essential factors.Materials and methodsThe patients involved were 31 infants with unilateral complete cleft lip and palate treated with primary cheiloplasty at the University of Tsukuba Hospital from 2004 to 2011. Of the 31 infants, 16 received nasoalveolar molding treatment and 15 received passive orthopedic treatment as controls. Photographic facial measurements were performed for all patients immediately and 7 months after primary cheiloplasty. The esthetics of the nostrils were assessed according to the left–right nostril symmetry, as measured by the Hausdorff distance, area ratio, perimeter ratio, and aspect a/u (the aspect ratio of the affected side)/(the aspect ratio of the unaffected side) ratio. In addition, the inclination of the nasal ridge was assessed using anthropometric measurements (Grc‐Grn∠midline and midline∠columellar axis).ResultsThe area ratio, perimeter ratio, and Grc‐Grn∠midline were significantly greater in the nasoalveolar molding group immediately after surgery (p = 0.00062, 0.016, and 0.048, respectively) than in the control group. However, the Hausdorff distance and aspect a/u ratio were more favorable (p = 0.0018 and 0.0039, respectively) in the nasoalveolar molding group after 7 months.ConclusionsThe results of our study suggested that using nasoalveolar molding as a presurgical orthopedic treatment could improve the shape of the nasal cartilage with surgeon's corrections.

3D morphometric evaluation of the dental arches in children with cleft lip and palate submitted to different surgical techniques.

This study aimed to compare dimensional alterations of dental arches in children with unilateral complete cleft lip and palate before and after different techniques of primary plastic surgeries. The sample was divided into two groups: group 1-cheiloplasty by Millard's technique and one-stage palatoplasty by von Langenbeck's technique; group 2-cheiloplasty by Millard's technique and two-stage palatoplasty: anterior palatoplasty by Hans Pichler's technique and posterior palatoplasty by Sommerlad's technique. Dental arches were evaluated before (T1), after the first phase (T2), and 1year after the second phase (T3) of primary surgeries. Linear measurements and palatal area were assessed. To analyze the method's error, interclass correlation coefficient was applied. ANOVA (followed by Tukey test), dependent, and independent t-test were used (p < 0.05). At T1, the intertuberosity distance was statistically greater in G2 (p = 0.004). At T2, the anterior length of the dental arch was statistically greater in G2 (p = 0.025), while the area of the smaller palatal segment (p = 0.001), cleft area (p = 0.014), and total area (p = 0.002) were statistically smaller in G2. At T3, the intertuberosity distance was statistically greater in G2 (p = 0.017). This study suggests that cheiloplasty and one-stage palatoplasty resulted in smaller growth of maxilla than cheiloplasty and two-stage palatoplasty in the linear measurements (T-T' and I-CC') and total area of the dental arches. Surgical protocols need to be evaluated to verify their effects aiming at improving the clinical practice of the interdisciplinary team, determining new parameters for the rehabilitation of individuals with cleft lip and palate.

Treatment Outcome in Bilateral Cleft lip and Palate Patients Evaluated With the Huddart-Bodenham Scoring System and the Bilateral Cleft lip and Palate Yardstick: A Systematic Review.

ObjectivesTo assess treatment outcome (transversal and sagittal dental arch relationships) and its determinants in complete bilateral cleft lip and palate (BCLP) evaluated with the modified Huddart-Bodenham scoring system and the BCLP Yardstick.Materials and methodsMultiple electronic databases were searched without time limitation. Randomized clinical trials, cohort and case control studies using BCLP Yardstick and/or modified Huddart-Bodenham system to judge treatment outcome of patients with BCLP were included. The Risk of Bias in Nonrandomized Studies of Interventions tool and Grading of Recommendations, Assessment, Development, and Evaluation was used.ResultsOf the 528 studies identified by the electronic search, only eight retrospective studies met the inclusion criteria and were included. A total of 12 cleft centers were represented. All treatment protocols differed and background information was underreported. The results for the BCLP yardstick showed that all except the centers in New Zealand had a mean score lower than 3, indicating good treatment results. However, these studies had a moderate to high risk of bias. The modified Huddart-Bodenham scores were negative in all studies. No further meta-analysis was done due to heterogeneity and high risk of bias. The quality of evidence was graded as very low.ConclusionResults for the dental arch relationship of studies in complete BCLP and possible determinants were not synthesized due to very low quality of evidence. Clinical research for patients with BCLP should focus on sound methodological designs to enable evidence-based decision making to improve treatment for patients with BCLP and thereby hopefully their quality of life.

Graft Materials and Canine Vertical Position Associated with Alveolar Bone Graft Outcomes Assessed by 3D Cone Beam CT

The introduction of Cone Beam Computed Tomography (CBCT) into the alveolar bone grafting protocol now allows surgeons to look at pre- and postoperative bony structures to determine surgical success. Until recently, pre- and postoperative assessment have been determined by 2-dimensional (2D) periapical and panoramic radiographs. CBCTs can now be used to volumetrically assess defects. Yet to date, no scale has been standardized to classify alveolar bone grafting levels postoperatively to determine the success of the procedure. This study aims to analyze pre- and postoperative cone bean CBCT scans to determine if variables such as cleft size, canine position, and bone grafting material can help predict surgical outcomes. A total of 79 patients (average 10.4 years) with non-syndromic complete unilateral cleft lip and palate had been treated with ABG and bone morphogenetic protein-2 with demineralized bone matrix (BMP2/DBM) versus iliac crest bone (ICB) were compared. Preoperative CBCT scans (n = 27) were available to determine the cleft width. The postoperative CBCT was analyzed by the Bergland scale score. A novel method for categorizing canine eruption separated post-graft patients into 5 groups. The cleft width might be correlated with bone graft outcomes, but limited to the sample size, with no statistical significance (n = 27, R2 = 0.378, P > .05). In total, 21 (26.6%) patients have supernumerary or impacted teeth in the cleft, but not related to bone graft outcomes. There is no statistical difference between the 4 surgeons’ cleft repair. The 2D modalities traditionally used to interpret SABG results possess inherent limitations of structure overlapping and distortion of the relationship of anatomy. Since the advent of the CBCT, 3D volumetric analysis has largely accounted for these errors. Yet to date, no scale standardized to the CBCT has been developed to assess SABG results.The authors' results suggest that graft outcomes correlate with pre-graft canine positions. An unerupted, high permanent canine vertical position will yield poor results, likely due to previously documented growth-inhibiting scarring of soft tissue, and the ideal timing of SABG may be when two-thirds of the canine crown is located below the palatal plane with the adjacent premolars not fully erupted. This may be due to the optimal timing for the canine to complete its eruption into the grafting site to influence the maintenance of the graft and periodontal support of the adjacent teeth. In a patient with complete unilateral cleft lip and palate, iliac crest bone graft tended to have better graft outcomes than BMP2/DBM in this sample. This may be attributed to BMP2/DBM's osteoconductive properties vs. ICB's osteogenic, osteoinductive, and osteoconductive properties. There was no evidence that cleft width correlates with the grafting outcome. However, results were limited to sample size.

Characterization of phenotypes and predominant skeletodental patterns in pre-adolescent patients with Pierre-Robin sequence.

ObjectiveTo investigate the phenotypes and predominant skeletodental pattern in pre-adolescent patients with Pierre–Robin sequence (PRS).MethodsThe samples consisted of 26 Korean pre-adolescent PRS patients (11 boys and 15 girls; mean age at the investigation, 9.20 years) treated at the Department of Orthodontics, Seoul National University Dental Hospital between 1998 and 2019. Dental phenotypes, oral manifestation, cephalometric variables, and associated anomalies were investigated and statistically analyzed.ResultsCongenitally missing teeth (CMT) were found in 34.6% of the patients (n = 9/26, 20 teeth, 2.22 teeth per patient) with 55.5% (n = 5/9) exhibiting bilaterally symmetric missing pattern. The mandibular incisors were the most common CMT (n = 11/20). Predominant skeletodental patterns included Class II relationship (57.7%), posteriorly positioned maxilla (76.9%) and mandible (92.3%), hyper-divergent pattern (92.3%), high gonial angle (65.4%), small mandibular body length to anterior cranial base ratio (65.4%), linguoversion of the maxillary incisors (76.9%), and linguoversion of the mandibular incisors (80.8%). Incomplete cleft palate (CP) of hard palate with complete CP of soft palate (61.5%) was the most frequently observed, followed by complete CP of hard and soft palate (19.2%) and CP of soft palate (19.2%) (p < 0.05). However, CP severity did not show a significant correlation with any cephalometric variables except incisor mandibular plane angle (p < 0.05). Five craniofacial and 15 extra-craniofacial anomalies were observed (53.8% patients); this implicated the need of routine screening.ConclusionsThe results might provide primary data for individualized diagnosis and treatment planning for pre-adolescent PRS patients despite a single institution-based data.

Effect of Nasoalveolar Molding in Infants with Cleft Lip & Palate

In the 19 th century McNeil (prosthodontist) used an oral prosthesis to approximate the cleft alveolar segments and thus initiating the concept of modern presurgical infant orthopedics. More recently (1994) Barry Grayson developed a new technique that not only it approximates the alveolar segments, but it also reshapes the nose in order to perform primary nose surgery, this technique is called Nasoalveolar molding (NAM). Patients with nonsyndromic complete unilateral cleft lip and palate. Nasoalveolar molding was performed for each patient and treatment time took 8-12 weeks. A serial of standard basilar view 1:1 photographs were taken for each patient. Each patient was photographed at the initial visit and after the nasoalveolar molding. Digital caliper was used to measure the cleft size on the study model at the initial visit and after nasoalveolar molding. Patients expressed good improvement. The cleft size was reduced significantly. Improved both the columella deviation and length as well as the nostril width and height in the cleft side. NAM is an effective procedure in reducing the alveolar cleft size and it also improves the nasal architecture. This will facilitate the work of the plastic surgeon during the lip adhesion and primary nose surgery and consequently with better aesthetic outcome.

Comparative evaluation of nasal and alveolar changes in complete unilateral cleft lip and palate patients using intraoral and extraoral nasoalveolar molding techniques: randomized controlled trial.

ObjectivesCleft lip and palate is a common congenital anomaly that impairs the aesthetics, speech, hearing, and psychological and social life of an individual. To achieve good aesthetic outcomes, presurgical nasoalveolar molding (NAM) has become important. Currently, the intraoral NAM technique is widely practiced. Numerous modifications have been made to intraoral NAM techniques, but the original problem of compliance leading to discontinuation of treatment remains unsolved. Therefore, the present study compared an extraoral NAM technique with the intraoral NAM technique.Materials and MethodsTwenty infants with complete unilateral cleft lip and palate were included and divided into two equal groups. Group A received the intraoral NAM technique, and Group B received the extraoral NAM technique. Pre- and postoperative extraoral and intraoral measurements were recorded.ResultsGroups A and B did not differ significantly in any extraoral or intraoral parameter.ConclusionThe extraoral NAM technique is as effective as the intraoral NAM technique in achieving significant nasal and alveolar changes in complete unilateral cleft lip and palate patients. Additionally, it reduces the need for frequent hospital visits for activation and the stress associated with the insertion and removal of the intraoral NAM plate, thereby improving compliance.

The Application of Buccal Fat Pad to Cover Lateral Palatal Defect Causes Early Mucolization.

IntroductionCleft lip and cleft palate are among the most common birth defects. These deformities lead to profound psychosocial and functional effects on cleft palate patients. Several surgical techniques have been described for the repair of the cleft. The defects lateral to mucoperiosteal flaps closure are sometimes covered with sterile gauze soaked with soft paraffin or tincture of benzoin or are left open for mucolization by means of secondary intention. The buccal fat pad (BFP) is used as a pedicled graft to cover the exposed bone of the lateral palatal defect, and it is associated with proposed benefits of early healing and fewer effects on transverse growth of the maxilla.Materials and methodsThis was a prospective study involving 42 cleft palate patients who underwent cleft palate repair; 21 patients received BFP as an additional step to cover lateral palatal defect while the rest of the patients (n=21) underwent conventional surgical cleft palate repair and the defect was covered with Surgicel (Ethicon, Inc., Bridgewater, NJ). Postoperative follow-up was conducted at first, second, and third weeks postoperatively to assess the time required for mucolization.ResultsOur cohort of 42 patients included an equal number of complete and incomplete cleft palate patients. Follow-up at the first postoperative week showed an equal number (n=21, 100%) patients with incomplete mucolization on both groups, while at the second postoperative follow-up, only one (4.8%) of the patients who underwent conventional cleft palate repair had complete mucolization while 20 (95.2%) among the patients who underwent BFP had complete mucolization. At the third-week postoperative follow-up, three (14.3%) patients from the conventional group had complete mucolization, while 18 (85.7%) had incomplete mucolization. Only two patients (4.8%) developed recipient area complications, and they were managed conservatively.ConclusionBFP is a good source of vascularized tissue to cover the hard palate bones after primary cleft repair. It is easy to harvest as a local tissue with a low learning curve. The epithelialization rate is faster than conventional methods with minimal complication rates.

Evaluation of cheiloplasty and palatoplasty on palate surface area in children with oral clefts: longitudinal study

This study evaluated the palatal surface area in children with different oral clefts after primary surgeries and at five years of age. This longitudinal study was composed by 216 digital models: unilateral complete cleft lip (UCL), unilateral complete cleft lip and palate (UCLP), and complete cleft palate (CP). The models were analysed at four time periods: T1 (before cheiloplasty), T2 (before palatoplasty), T3 (after palatoplasty); and T4 – (at five years of age). Area of the dental arches was measured through stereophotogrammetry software. Measurements evaluated with Student’s test and ANOVA followed by the Tukey test (p<0.05) (AQ 1). In the UCL group, the palatal surface area significantly increased among phases. In the primary surgery periods, UCLP and CP significantly decreased (p<0.001). Palatal area in the UCLP group was significantly greater than the CP group. Overall, no statistically significant differences occurred among groups. At T4, the area of the palate in the UCL group was significantly greater than the UCLP group and no significant differences occurred between UCLP and CP groups. This study suggests that cheiloplasty did not inhibit the growth of the palatal surface area in children with UCL and UCLP. Palatoplasty significantly decreased the palatal area in children with UCLP and CP, demonstrating a significant negative effect of palatal repair on maxillary growth. At five years, children with UCLP and CP had a significantly smaller palate area than those with UCL.

One-Year Stability of LeFort I Advancement in Patients With Complete Cleft Lip and Palate Using a Standardized Clinical and Surgical Protocol.

To assess treatment outcome and 1-year stability of LeFort I advancement in patients with complete cleft lip and palate. Thirty-five patients (age 20.65 ± 2.20 years) with unilateral (n = 25) or bilateral (n = 10) complete cleft lip and palate who underwent LeFort I advancement were included.Lateral cephalograms before surgery (T1), immediately postsurgery (T2), and at 1-year follow-up (T3) were superimposed, and the position of anterior nasal spine (ANS), A-point, and U1 Tip assessed using an x, y coordinate system. Differences between landmark positions at the 3-time points were analyzed using paired sample t-tests, with a significance defined as α ≤ 0.05. The mean surgical advancement in the horizontal direction (T2-T1) was 6.50 ± 2.62 mm at ANS (P < 0.001) and 7.05 ± 2.51 mm at A-point (P < 0.001). At a 1-year follow-up (T3-T2), the mean horizontal relapse at ANS was -1.41 ± 1.89 mm (P < 0.001) and -0.79 ± 1.48 mm at A-point (P 0.003). Mean horizontal relapse was 21.7% and 11% of surgical advancement when assessed at ANS and A-point, respectively. The central incisor tip position remained stable during the postsurgical period (0.12 ± 2.11 mm, P 0.732). At A-point, the mean vertical surgical change (T2-T1) was -0.96 ± 2.57 mm (P < 0.001). No significant post-treatment (T3-T2) vertical changes were detected at ANS or A-point. Phenotypic stability was excellent, with all patients maintaining positive overjet at 1-year follow-up. LeFort I advancement in complete cleft lip and palate is stable, with less than a 2 mm relapse after 1-year. Surgical overcorrection by 10% to 20% is recommended to compensate for the expected skeletal relapse.

Final Posttreatment Occlusion in Patients With Unilateral Cleft Lip and Palate.

Objective:To evaluate final posttreatment occlusion in patients with complete unilateral cleft lip and palate (cUCLP) by comparing (1) 3 treatment centers, (2) males and females, (3) cleft and noncleft sides, (4) right- and left-sided clefts, and (5) orthodontic treatment with/without orthognathic surgery (OS).Design:Retrospective cohort study.Patients:Blinded posttreatment dental casts of 56 patients (19.4 ± 1.4 years) with cUCLP from 3 centers in Switzerland.Main Outcome Measure:Occlusal assessment using the modified Huddart/Bodenham (MHB) index.Results:Our sample comprised 35 males and 21 females, 46 with left- and 10 with right-sided clefts, of which 32 had undergone OS. The final posttreatment occlusion showed a median MHB score of 0 (interquartile range: −1.0 to 2.0) in the total sample and did not seem to depend on treatment center, sex, or OS. The MHB scores for the anterior buccal and the buccal segments were more negative on the cleft than on the noncleft side (P = .002 and P = .006, respectively). When the cleft was on the left side, the MHB score tended to be more positive in the labial (P = .046) and anterior buccal segments (P = .034).Conclusions:This study shows a very satisfactory final posttreatment occlusion in patients with cUCLP. The more constricted buccal occlusion on the cleft side emphasizes the attention that should be given in correcting the more medially positioned lesser maxillary segment. The influence of cleft-sidedness should be analyzed further on a sample including more patients with right-sided clefts.