06-053%2E1

7/27/2019 06-053%2E1

http://slidepdf.com/reader/full/06-0532e1 1/8

7/27/2019 06-053%2E1


Others (Ortiz-Monasterio et al., 1966; Mars and Houston,

1990; Capelozza et al., 1993) have stated that the maxillary

deficiency is primarily a result of surgical repair. These

citations are illustrative of opposing views and of the

difficulties inherent in conducting clinical studies.

This study was conducted to delineate factors that may

contribute to severe maxillary hypoplasia requiring maxil-

lary advancement surgery in individuals with nonsyndro-

mic UCLP. Early determination regarding the need for

such a procedure is important as it influences the timing

and type of orthodontic treatment.

METHODS

Subjects

The subjects were collected from the University of

California, San Francisco (UCSF), Center for Craniofacial

Anomalies computer database using the key words

unilateral cleft lip and palate and Le Fort I . All UCLP

individuals were included as the beginning sample frame.

Sixteen individuals met our inclusion criteria of confirmed

diagnosis of nonsyndromic UCLP who required surgical

maxillary advancement and had complete clinical recordsincluding at least two lateral cephalograms at the chosen

time points and for whom a matched control individual of

same age, cleft type, and gender with lateral head films was

available. The mean ages at the time points were 10.7 years

(T1), 13.3 years (T2), and 15.8 years (T3) in the Le Fort

group (Table 1).

The nonsyndromic matched control group was selected

from the same database using the search terms unilateral

cleft lip and palate. The matched control group was

composed of individuals whose year of birth was within

6 months of the corresponding study individual. The mean

ages were 10.11 years at T1, 12.9 years at T2, and15.7 years at T3 (Table 1).

Methods

Chart reviews were performed and clinical information

gathered and noted for all the study and control

individuals. All lateral cephalometric head films had been

taken on the same cephalostat, with a magnification of

9.8%. The films were scanned (U Max Power Look 1100;

Techville Inc., Dallas, TX), and a total of 53 hard and soft

tissue landmarks were digitized using Dolphin Imaging

Version 8.2 (Dolphin Imaging and Management Solutions,

Canoga Park, CA) software. Thirty-one angular and linear

measurements were analyzed (Fig. 1; Table 2). In addition,

the maxillo-mandibular relationship was assessed by

calculating the difference between mandibular unit length

and maxillary unit length.

Approval for this study was granted by the Committee

on Human Research at UCSF.

Statistical Analysis

Intraclass correlation measures across 31 variables on

repeated measurements showed that the median intraclass

correlation was .96, with values ranging from .95 to .98,

indicating excellent reliability. The Wilcoxon matched-pairs

signed-rank test with 95% confidence interval was used for

all cephalometric measurements at all time points.

RESULTS

Cephalometric Findings

The midface length measured from condylion (Co) to the

A point was significantly smaller in the Le Fort group at all

three time points, ranging from 73 mm at T1 to 80 mm at

T3 versus 83 mm at T1 to 89 mm at T3 in the nonsurgical

cleft control group. By definition, those who required

surgical maxillary advancement had more midface hypo-

plasia, and this was clear as early as T1 (Fig. 2; Tables 3

through 5). Maxillary unit length (Co-Ans) was 74 mm in

the surgery group and 85 mm in the cleft controls at T1.

Both groups had a similar increase in the maxillary AP

dimensions from T1 to T3 (Fig. 3).

The skeletal discrepancy represented by the mandibular

and maxillary unit length differences was significantly

different between the two groups at all time points: at T1 ( p

, .01), at T2 ( p , .0009), and at T3 ( p , .0005). The unit

TABLE 1 Descriptive Statistics*

UCLP Male Female T1 T2 T3

Le Fort I 10 6 10.7 13.3 15.8

Controls 10 6 10.11 12.9 15.7

* UCLP 5 unilateral cleft lip and palate; T1, T2, T3 5 time points in years.

FIGURE 1 Landmarks measured (refer to Table 2 for abbreviations).

Oberoi et al., UCLP AND MAXILLARY ADVANCEMENT 43

7/27/2019 06-053%2E1


differences in the Le Fort group were 32 mm at T1, 36 mm

at T2, and 40 mm at T3, compared with 18 mm, 24 mm,

and 28 mm, respectively, in the UCLP controls (Table 6).

The maxillary and mandibular unit length differences in the

UCLP controls were similar to the age-matched standards

from the Burlington growth study (Thompson and

Popovich, 1977).

The ANB angle was significantly smaller in the Le Fort

group at all three time points, decreasing from 22u to 25u

from T1 to T3, compared with 6u and 1.5u in the controls.

Both groups showed progressive maxillary deficiency, as

the maxilla did not keep up with mandibular growth

(Fig. 4).

The Wit’s analysis also showed that the maxilla was more

deficient in the Le Fort group at all three time points,

changing from 27 mm at T1 to 29 mm at T3, compared

with a change from 5 mm at T1 to 1 mm at T3 in the

UCLP control group.

Mandibular length was slightly greater in the Le Fort

group but was not statistically significant, indicating that in

most cases, maxillary deficiency and not mandibular

prognathism was the cause of the skeletal discrepancy

(Fig. 5). The lower incisors in the Le Fort group were

significantly more anterior to the A-Po line, resulting from

a retruded position of the A point.

The upper lip position was significantly farther back

from the E plane at all three time points: 26.4 mm at T1 to

27.2 mm at T3, compared with 21.4 mm at T1 and

24.8 mm at T3 in the nonsurgical controls.

The saddle angle was significantly smaller in the Le Fort

group at T1, but there was no difference observed at T2 and

T3.

TABLE 2 Abbreviations, Descriptions, and Definitions of Points and Measurements on Lateral Cephalometric Radiographs

Abbreviation Description Definition

A A point Deepest point of curve of maxilla, between anterior nasal spine (ANS) and dental

alveolus

B B point Most posterior point in the concavity along the anterior border of the symphysis

ANS Anterior nasal spine The tip of the anterior nasal spine

PNS Posterior nasal spine The tip of the posterior nasal spineBa Basion Most inferior posterior point of occipital bone at the anterior margin of occipital

foramen

Ar Articulare Posterior border of the condyle

Co Condylion Most posterior superior point of the condyle

Me Menton Most inferior point of the symphysis of mandible

Pg Pogonion Most anterior point of the mandible

OP Occlusal plane Functional occlusal plane located between the first molars and first bicuspids

PT Pteryg omax illary fissure p oint Intersection of in ferior b order of fora men rot undum with po sterior w all of

pterygomaxillary fissure

Po Porion Most superior point of external auditory meatus

Or Orbitale Lowest point of roof of orbit

S Sella Center of pituitary fossa of sphenoid bone

N Nasion Intersection of internasal suture with frontonasal suture in the midsagittal plane

G Gonion Most convex point along the inferior border of the Ramus

SNA Maxillary prognathism Angle formed between sella, nasion, and A point

N-A Maxillary prognathism Linear measurement between nasion perpendicular and A pointSNB Mandibular prognathism Angle formed between sella, nasion, and B point

N-Pg Mandibular prognathism Linear measurement between nasion perpendicular and B point

ANB Sagittal jaw relationship Angle formed between A point, nasion, and B point

MP-SN Mandibular plane angle Angle formed between mandibular plane and sella-nasion plane

OP-SN Occlusal plane sella-nasion Angle formed between occlusal plane and sella-nasion plane

FMA Mandibular plane angle Angle formed between Frankfurt plane and mandibular plane

Y-axis Y-axis Angle formed between S-Gn and S-N

LFH Lower face height Linear measurement of Ans-Me

A-Po Lower incisor protrusion Linear measurement of lower incisor tip to A-Po line

Eplane Rickett’s Eline Line between nasal tip and soft tissue chin point

FIGURE 2 Midface length for Le Fort I and controls.

44 Cleft Palate–Craniofacial Journal, January 2008, Vol. 45 No. 1

7/27/2019 06-053%2E1


The mandibular plane angle was significantly steeper in

the Le Fort group at T1, but this trend did not continue at

T2 and T3. However, the mandibular plane angle was

steeper in both groups as compared with normal values in

noncleft individuals.

Clinical Findings

There was a higher incidence of missing maxillary teeth

in the Le Fort group, with almost twice the number missing

as compared with the cleft controls ( p , .05). In both

groups, 54% of the missing teeth were lateral incisors, all on

the cleft side. There were more missing teeth outside the

cleft in the Le Fort group (46%) compared with the UCLP

controls (6%). The most commonly missing tooth was the

maxillary second premolar, twice more commonly missing

on the right (21%) than on the left side (10%).

There was a greater average number of surgical

procedures in the Le Fort group (3.5), compared with

2.25 in the UCLP controls ( p , .05). These were primarily

secondary palate procedures and fistula repairs. Four of the

Le Fort individuals had a pharyngeal flap combined with

the primary palate repair, and all had secondary palate

procedures, including secondary pharyngeal flaps in four

individuals. Only 2 of the 16 Le Fort individuals had their

initial lip and palate repair by the team surgeon. In thecontrol group, only one individual had a secondary

pharyngeal flap. The team surgical procedure for palate

repair was predominantly the Furlow z-plasty, completed

before 1 year of age. In the Le Fort group, only two

individuals had consistent team care from infancy, while

the others came to the team at various ages. Eight of the

matched UCLP controls had consistent team care from

infancy, and all were in consistent team care after the age of

9 years.

All individuals had orthodontic treatment, but phase 1

treatment was provided only to those who had team care at

the appropriate age. The mean age for the orthodontic

TABLE 3 Statistical Analysis of Cephalometric Measurements for Le Fort I and Control Groups at T1

Cranial Base Measurement Le Fort I 95% Confidence

Interval Control 95% Confidence

Interval Wilcoxon Signed-Rank p

Value

Anterior cranial base 63.37 (3.09) 60.50 to 66.23 67.65 (3.72) 64.21 to 71.09 .078

Posterior cranial base 30.31 (3.97) 26.63 to 33.98 32.80 (2.22) 30.74 to 34.85 .171

Saddle angle 116.11 (4.05) 112.36 to 119.86 122.17 (3.77) 118.68 to 125.66 .031*

Sagittal maxillary measurements

SNA 80.94 (3.62) 77.58 to 84.29 84.14 (4.28) 80.18 to 88.10 .687

N-A 22.40 (3.11) 25.28 to 0.48 0.44 (4.4) 23.64 to 4.52 .687

Midface length Co-A 73.26 (4.46) 69.13 to 77.38 82.90 (3.93 ) 79.26 to 86.53 .031*

Maxillary unit length Co-Ans 74.90 (3.88) 71.31 to 78.49 85.07 (3.48) 81.85 to 88.29 .015*

Sagittal mandibular measurements

SNB 82.84 (4.64) 78.55 to 87.14 78.05 (2.88) 75.39 to 80.72 .109

N-Pg 21.57 (5.19) 26.37 to 3.23 28.18 (6.34 ) 214.05 to 22.31 .218

Mandibular unit length Co-Pog 105.47 (5.73) 100.17 to 110.77 100.80 (5.84) 95.39 to 106.20 .375

Sagittal jaw relationship measurements

ANB 21.90 (3.71) 25.33 to 1.53 6.11 (3.12) 3.22 to 9.00 .046*

Wits 27.31 (4.83) 211.78 to 22.85 4.84 (2.94) 2.12 to 7.56 .015*

Vertical maxillary and mandibular measurements

MP-SN 36.71 (3.39) 33.58 to 39.85 31.14 (4.24) 27.21 to 35.06 .046*

OP-SN 14.83 (5.81) 9.45 to 20.21 12.28 (4.22) 8.38 to 16.19 .578FMA 37.06 (6.44) 31.10 to 43.01 28.08 (3.70) 24.65 to 31.51 .015*

Y-axis 66.71 (3.89) 62.17 to 70.33 66.64 (1.32) 65.41 to 67.86 1.00

LFH 67.31 (3.52) 64.05 to 70.57 64.54 (6.61) 58.42 to 70.65 .156

% LFH 59.50 (3.14) 56.60 to 62.40 57.28 (2.95) 54.55 to 60.01 .156

Dentoalveolar measurements

Upper incisor–SN 100.26 (9.79) 91.20 to 109.31 93.80 (10.90) 83.71 to 103.88 .296

Upper incisor–APo 1.09 (3.01) 21.70 to 3.87 1.71 (3.65) 21.66 to 5.09 1.00

Upper incisor–NA 19.34 (9.64) 10.42 to 28.26 9.67 (8.47) 1.83 to 17.51 .078

Upper incisor–NA (mm) 2.89 (2.91) 0.20 to 5.57 22.71 (1.75) 24.33 to 21.08 .015*

Lower incisor–MP 38.10 (3.36) 34.99 to 41.21 38.02 (1.77) 36.39 to 39.66 .937

Lower incisor–APo 3.51 (2.39) 1.30 to 5.72 20.41 (2.06) 22.31 to 1.49 .031*

Lower incisor–NB 18.36 (6.58) 12.27 to 24.44 21.04 (5.4) 16.01 to 26.06 .468

Lower incisor–NB (mm) 3.01 (1.75) 1.393 to 4.64 3.07 (1.58) 1.60 to 4.53 .812

Interincisal angle 144.20 (5.95) 138.70 to 149.70 143.20 (13.00) 131.17 to 155.22 .937

Soft tissue measurementsUpper lip to E plane 26.49 (1.72) 28.08 to 4.89 21.42 (2.1) 20.41 to 0.55 .015*

Lower lip to E plane 20.11 (2.70) 22.61 to 2.38 1.01 (1.51) 20.38 to 2.41 .468

Nasolabial angle 105.97 (8.13) 98.45 to 113.49 108.08 (10.83) 98.09 to 118.10 .812

Chin angle 67.10 (7.04) 60.59 to 73.61 74.14 (6.04) 68.54 to 79.73 .109

* p , .05.


7/27/2019 06-053%2E1


intervention was 15 years in the Le Fort group versus

9 years in the controls.

To address the question as to whether the UCLP non–Le

Fort surgery controls had maxillary development within

the normal range, we compared the maxillary and

mandibular measurements at T3 with normative data for

noncleft individuals from the Burlington Growth Study

(Thompson and Popovich, 1977). Maxillary unit length,

SNA, SNB, and ANB for the nonsurgical cleft controls

were close to the norms for the noncleft controls (Table 7).

DISCUSSION

This study was designed to delineate features that

characterize and may contribute to maxillary hypoplasia

in nonsyndromic individuals with UCLP. It is well

recognized that individuals with repaired UCLP show

variation in the degree of maxillary hypoplasia. A certain

number will require surgery to advance the maxilla. This

number varies among studies, and the morphologic and

functional characteristics used to determine the need for

maxillary surgery are not well defined. In a large Toronto

sample of UCLP adult males, Ross (1987) noted that

orthognathic surgery would be necessary in 25% of the

sample to achieve adequate functional relation of the jaws,

harmonious facial esthetics, or both. In an outcomes study

from the United Kingdom on 218 UCLP patients (Williams

et al., 2001), 70% of the patients had midface retrusion at

age 12, and 40% of these would eventually require

orthognathic surgery to correct the skeletal discrepancy.

In a long-term retrospective outcome assessment of facial

growth (Rosenstein et al., 2003), the incidence of orthog-

nathic surgery was 18.29%. At our center, 14% of all

individuals with nonsyndromic UCLP born between 1971

and 1990 had Le Fort I surgical advancement.

In our study sample of Le Fort patients, significant

midface hypoplasia was documented at the first time point

and became more marked toward the end of growth. When




Interval Wilcoxon Signed-Rank

p Value



Saddle angle 122.65 (8.10) 117.97 to 127.33 124.89 (5.96) 121.45 to 128.33 .542


SNA 78.06 (4.60) 75.40 to 80.71 81.29 (3.49) 79.27 to 83.30 .035*

N-A 24.79 (5.06) 27.72 to 21.87 21.51 (3.99) 23.81 to 0.79 .009*

Midface length Co-A 79.87 (4.89) 77.05 to 82.70 86.34 (4.89) 83.51 to 89.16 .000*



SNB 82.06 (4.91) 79.23 to 84.89 78.18 (3.68) 76.05 to 80.30 .079

N-Pg 20.61 (9.85) 26.30 to 5.08 27.42 (9.08) 212.67 to 22.18 .068



ANB 23.99 (4.28) 26.47 to 21.52 3.11 (2.51) 1.66 to 4.57 .001*

Wits 26.96 (5.28) 210.01 to 23.92 1.13 (2.19) 20.14 to 2.40 .000*


MP-SN 37.25 (4.95) 34.39 to 40.11 34.86 (6.36) 31.20 to 38.53 .400

OP-SN 12.26 (8.43) 7.40 to 17.13 14.06 (5.04) 11.15 to 16.97 .808FMA 34.86 (6.22) 31.27 to 38.46 30.57 (6.41) 26.87 to 34.27 .153

Y-axis 66.84 (4.17) 64.43 to 69.25 68.01 (3.11) 66.22 to 69.81 .426

LFH 70.89 (4.18) 68.48 to 73.31 68.33 (4.93) 65.48 to 71.18 .148

% LFH 59.00 (3.50) 56.98 to 61.02 57.10 (2.21) 55.82 to 58.38 .068



Upper incisor–APo 2.18 (2.77) 0.58 to 3.78 3.03 (1.72) 2.04 to 4.03 .262


Upper incisor–NA (mm) 6.01 (4.52) 3.40 to 8.63 1.08 (2.68) 20.47 to 2.63 .002*




Lower incisor–NB (mm) 4.54 (2.88) 2.88 to 6.20 4.14 (2.24) 2.84 to 5.43 .583





Chin angle 65.09 (5.05) 62.17 to 68.00 72.36 (5.56) 69.15 to 75.58 .001*

* p , .05.


7/27/2019 06-053%2E1


we assessed the maxillo-mandibular relationship, it was clear

that the need for maxillary surgery could be determined as

early as 10 to 12 years of age and possibly earlier. The

difference between mandibular unit length and maxillary

unit length is a good indicator of jaw size relationship. In the

Le Fort group, the average difference was 32 mm at T1,

36 mm at T2, and 40 mm at T3, significantly larger than the

differences in the UCLP control group at 18 mm, 24 mm,

and 28 mm at T1, T2, and T3, respectively (Table 6). The

unit difference of 32 mm in the 10- to 12-year group was well

outside the normal range and would predict the need for

maxillary advancement surgery. Based on Harvold’s analysis

of data from the Burlington Growth Study (Proffit et al.,

2003), a jaw size discrepancy with a mandibular length more

than 30 mm greater than maxillary length will require

surgical correction.

There was a higher incidence of missing teeth in the Le

Fort group, with almost twice the number missing as

compared with the cleft controls. Shapira et al. (2000) have

shown the presence of hypodontia in 77% of individuals

with nonsyndromic cleft lip and palate. They also found

that maxillary permanent lateral incisors were the teeth

most frequently missing (74%) on the cleft side, followed by

the maxillary and mandibular second premolars, similar to

our finding. The larger number of missing teeth in the

maxilla contributes to a smaller dental arch. This is an

intrinsic tissue deficiency factor.

On average, the Le Fort group had a larger number of

palatal surgical procedures, including four primary and

four secondary pharyngeal flaps. Every surgical procedure

results in scarring. A pharyngeal flap ties the soft palate to

the posterior pharyngeal wall. In our study, it was apparent

that the individuals who had primary and early secondary

pharyngeal flaps had significant maxillary hypoplasia. The

literature is inconsistent on the effects of pharyngeal flaps

on maxillary growth (Keller et al., 1988; Semb and Shaw,

1990). In our sample, it appeared to be a significant

contributing factor.




Interval Wilcoxon Signed-Rank

p Value



Saddle angle 123.10 (5.89) 119.70 to 126.50 121.98 (6.55) 118.20 to 125.76 .987


SNA 76.93 (4.93) 74.08 to 79.77 80.43 (5.97) 76.98 to 83.87 .194

N-A 26.26 (5.10) 29.20 to 23.31 22.90 (6.25) 26.51 to 0.71 .178

Midface length Co-A 79.95 (5.09) 77.01 to 82.89 86.34 (6.54) 82.56 to 90.11 .000*



SNB 81.56 (4.25) 79.10 to 84.01 78.94 (6.01) 75.47 to 82.41 .210

N-Pg 20.71 (8.75) 25.76 to 4.34 26.47 (11.98) 213.39 to 0.44 .119



ANB 24.64 (3.92) 26.90 to 22.38 1.49 (3.35) 20.44 to 3.43 .000*

Wits 28.81 (6.26) 212.43 to 25.20 1.04 (4.51) 21.57 to 3.64 .000*


MP-SN 36.81 (5.23) 33.80 to 39.83 34.22 (7.18) 30.07 to 38.37 .391

OP-SN 13.32 (9.55) 7.81 to 18.84 11.46 (5.66) 8.19 to 14.72 .622FMA 34.88 (5.32) 31.81 to 37.95 30.30 (7.22) 26.13 to 34.47 .122

Y-axis 67.69 (5.04) 64.78 to 70.60 68.26 (4.50) 65.67 to 70.86 .626

LFH 75.14 (8.07) 70.48 to 79.79 72.91 (6.57) 69.12 to 76.71 .334

% LFH 59.33 (2.57) 57.85 to 60.81 57.97 (2.84) 56.33 to 59.61 .131



Upper incisor–APo 3.13 (3.88) 0.89 to 5.37 5.36 (3.06) 3.60 to 7.13 .153


Upper incisor–NA (mm) 8.09 (4.29) 5.61 to 10.57 4.96 (3.79) 2.78 to 7.15 .101




Lower incisor–NB (mm) 4.76 (3.63) 2.66 to 6.85 4.47 (2.06) 3.28 to 5.66 1.000





Chin angle 63.49 (7.02) 59.43 to 67.54 71.15 (4.88) 68.33 to 73.97 .020*

* p , .05.


7/27/2019 06-053%2E1


The fact that early orthodontic expansion was not

provided for most of the Le Fort individuals must also be

considered a contributing factor to the growth differences

between the two groups. Consistent team care will ensure

that procedures such as maxillary expansion are done at the

appropriate time. Although not discussed here, team care is

also essential for many other reasons such as family

support, feeding, speech, genetics, and family planning.

SUMMARY AND CONCLUSIONS

Based on our findings, the need for maxillary advance-

ment surgery can be determined as early as 10 to 12 years

of age by the degree of jaw size discrepancy, as measured by

mandibular/maxillary unit length difference and the AP

position of the maxilla. Factors contributing to severe

maxillary hypoplasia can be congenitally missing teeth,

primary or early pharyngeal flap surgery, repeat palate

surgeries and delayed orthodontic intervention, and iatro-

genic factors associated with absent or inconsistent team

care. Consistent team care with a minimum number of

FIGURE 3 Maxillary unit length for Le Fort I and controls. FIGURE 4 ANB angle for Le Fort I and controls.

TABLE 6 Comparison of Unit Length Difference in Le Fort and Control

Groups at All 3 Time Points

Time Point

Unit Length Difference (mm)

p ValueLe Fort I Control

T1 32 18 ,.01

T2 36 24 ,.0009

T3 40 28 ,.0005

TABLE 7 Comparison of Maxillary Measurements in Nonsurgical

Unilateral Cleft Lip and Palate (UCLP) and Noncleft Controls

Maxillary Measurement Nonsurgical UCLP Noncleft Controls

Maxillary unit length (mm) 88.5 94

SNA (u) 80.5 81

SNB (u) 79 78

ANB (u) 1.5 3.0

FIGURE 5 Mandibular unit length for Le Fort I and controls.


7/27/2019 06-053%2E1


surgical procedures performed by team surgeons and timely

orthodontic intervention should be the standard for

treatment of UCLP individuals to reduce the need for

maxillary advancement surgery.

REFERENCES

Bishara SE. The influence of palatoplasty and cleft length on facial

development. Cleft Palate J . 1973;10:390–398.

Canfield MA, Ramadhani TA, Yuskiv N, Davidoff MJ, Petrini JR, Hobbs

CA, Kirby RS, Romitti PA, Collins JS, Devine O, et al. Improved

national prevalence estimates for 18 selected major birth defects—United

States, 1999–2001. MMWR CDC Surveill Summ. 2006;54:1301–1305.

Capelozza L Jr., Taniguchi SM, da Silva Junior OG. Craniofacial

morphology of adult unoperated complete unilateral cleft lip and

palate patients. Cleft Palate Craniofac J . 1993;30:376–381.

Casal C, Rivera A, Rubio G, Sentis-Vilalta J, Alonso A, Gay-Escoda C.

Examination of craniofacial morphology in 10-month to 5-year-old

children with cleft lip and palate. Cleft Palate Craniofac J . 1997;34:490–497.

Dahl E. Craniofacial morphology in congenital clefts of the lip and palate:

an x-ray cephalometric study of young adult males. Acta Odontol Scand . 1970;28(suppl 57):11.

Han BJ, Suzuki A, Tashiro H. Longitudinal study of craniofacial growth

in subjects with cleft lip and palate: from cheiloplasty to 8 years of age.

Cleft Palate Craniofac J . 1995;32:156–166.

Hayashi I, Sakuda M, Takimoto K, Miyazaki T. Craniofacial growth in

complete unilateral cleft lip and palate: a roentgeno-cephalometric

study. Cleft Palate J . 1976;13:215–237.

Horswell BB, Levant BA. Craniofacial growth in unilateral cleft lip and

palate: skeletal growth from eight to eighteen years. Cleft Palate J .

1988;25:114–121.

Isiekwe MC, Sowemimo GO. Cephalometric findings in a normal

Nigerian population sample and adult Nigerians with unrepaired

clefts. Cleft Palate J . 1984;21:323–328.

Johnson GP. Craniofacial analysis of patients with complete clefts of the

lip and palate. Cleft Palate J . 1980;17:17–23.KellerBG, LongRE Jr., GoldED,Roth MD.Maxillary dentalarchdimensions

following pharyngeal-flap surgery. Cleft Palate J . 1988;25:248–257.

Krogman WM, Mazaheri M, Harding RL, Ishiguro K, Bariana G, Meier

J, Canter H, Ross P. A longitudinal study of the craniofacial growth

pattern in children with clefts as compared to normal, birth to six

years. Cleft Palate J . 1975;12:59–84.

Mars M, Houston WJ. A preliminary study of facial growth and

morphology in unoperated male unilateral cleft lip and palate subjects

over 13 years of age. Cleft Palate J . 1990;27:7–10.

Ortiz-Monasterio F, Serrano A, Barrera G, Rodriguez-Hoffman H,

Vinageras E. A study of untreated adult cleft palate patients. Plast

Reconstr Surg . 1966;38:36–41.

Ozturk Y, Cura N. Examination of craniofacial morphology in children

with unilateral cleft lip and palate. Cleft Palate Craniofac J .1996;33:32–36.

Proffit WR, White RP, Sarver D. Contemporary Treatment of Dentofacial

Deformity. St. Louis: Mosby; 2003.

Rosenstein SW, Grasseschi M, Dado DV. A long-term retrospective

outcome assessment of facial growth, secondary surgical need, and

maxillary lateral incisor status in a surgical-orthodontic protocol for

complete clefts. Plast Reconstr Surg . 2003;111:1–13.

Ross RB. Treatment variables affecting facial growth in complete

unilateral cleft lip and palate. Cleft Palate J . 1987;24:5–77.

Schultes G, Gaggl A, Karcher H. A comparison of growth impairment

and orthodontic results in adult patients with clefts of palate and

unilateral clefts of lip, palate and alveolus. Br J Oral Maxillofac Surg .

2000;38:26–32.

Semb G, Shaw WC. Pharyngeal flap and facial growth. Cleft Palate J .

1990;27:217–224.

Shapira Y, Lubit E, Kuftinec MM. Hypodontia in children with various

types of clefts. Angle Orthod . 2000;70:16–21.

Smahel Z, Brousilova M, Mullerova Z. Craniofacial morphology in

isolated cleft palate prior to palatoplasty. Cleft Palate J .

1987;24:200–208.

Smahel Z, Mullerova Z. Craniofacial growth and development in

unilateral cleft lip and palate: clinical implications (a review). Acta

Chir Plast. 1995;37:29–32.

Thompson GW, Popovich F. A longitudinal evaluation of the Burlington

growth centre data. J Dent Res. 1977;56(spec no):C71–C78.

Vargervik K. Orthodontic management of unilateral cleft lip and palate.

Cleft Palate J . 1981;18:256–270.

Williams AC, Bearn D, Mildinhall S, Murphy T, Sell D, Shaw WC,

Murray JJ, Sandy JR. Cleft lip and palate care in the UnitedKingdom—the Clinical Standards Advisory Group (CSAG) Study.

Part 2: dentofacial outcomes and patient satisfaction. Cleft Palate

Craniofac J . 2001;38:24–29.

Yoshida H, Nakamura A, Michi K, Wang GM, Liu K, Qiu WL.

Cephalometric analysis of maxillofacial morphology in unoperated

cleft palate patients. Cleft Palate Craniofac J . 1992;29:419–424.


Documents

06-053%2E1