Study Of Crainofacial Morphology In Operated Patients With Complete Unilateral Cleft Lip And Palate During Pubertal Growth Spurt

Objective The study was to demonstrate the craniofacial morphology change of the operated patients with Complete Unilateal Clefe Lip and Palate(UCLP) during pubertal growth spurt, analyze the influences of the surgical closure of compelte cleft lip and palate in different growth stage of craniofacial hard and soft tissue,offer more reference for clinical orthodontists.Materials and Methods The craniofacial morphology of samples derived from Orthodontic Department,Tianjin Stomatological Hospital was evaluated by means of cephalometric analysis. The study group comprised 68 operated UCLP patients ranging in age from 8 to 26 years old,compared to age- and gender-matched 67 non-cleft individual normal occlusion standerd. All the samples were classified into pre-peaking of pubertal growth spurt ,peaking of pubertal growth spurt and post-peaking of pubertal growth spurt by the maturation stage of cervical vertebrae . Comparison of cephalometric measurements was made not only between UCLP patients and their corresponding control group,but among classifications in UCLP group according to skeletal maturation.Results The features and the regulation of craniofacial morphology ofoperated UCLP patients in the course of pubertal growth spurt were as follows:1. Posterior cranial length of pre-peaking UCLP patients was shorter comparedto the control. Generally, during the pubertal growth spurt ,the growth and the angle ofcranial structure were stable and undisturbed.2.The flattening of the midface due to retrognathic maxilla in UCLP patientswas significant compared to the control and unchangeable during the pubertal growth spurt. On the other hand,the mandible showed clockwise rotation as well as the lower dentoalveolar showed sagittale deficiency during the peak and post-peaking of pubertal growth spurt.3. During the whole growth period,both the upper and lower incisors were significantly retruded and the overjet was decreased compared to the control; moreover,the overjet was unchangeable while the overbite decreased after the peak of growth.4. The UCLP patients of pre-peaking stage were "average-angle" skeletal facial type but the vertical growth of maxilla and mandible were all insufficient compared to the control. In the peaking stage,the upper anterior facial height with UCLP was shorter too.After the peak,the skeletal facial type changed to" high-angle"and with the trend of open bite,the posterior facial height and the P/A facial height ratio were smaller in UCLP group than the control. In the same period ,the maxilla was detected a clockwise rotation.5.The mandible and the maxilla length were both shorter in UCLP patient compared to the control during the whole growth period. In the stage of the post-peaking the ramus height was shorter whereas the gonial angle was bigger in UCLP patients than the control. What is more,the maxilla and the gonial angle remained almost the same size during the pubertal growth spurt while the mandible length increased mostly during the peak and pre-peaking stages.6.The soft tissue profile analysis demonstrated facial convexity was smaller as well as the thickness of subnasale and the upper lip length in UCLP patients compared to the control. Besides,the facial convexities changed unsignificantly while the mentolabial sulcus was increasing during the whole growth period .The lip musle remained tense after surgical repair of lip and the nasal convexity reduced remarkably in the peak of growth .Conclusion1 .The sagittal changes of opetated UCLP patients were maxillary impaction , mandibular clockwise rotation and mental region protruded .The maxilla,mandible and the ramus of UCLP were more underdeveloped than the control. 2.The vertical impairment was detected. With the decreasing of posterior facial height in the course of growth,vertical facial type was changing to "high-angle" .3. The upper and lower incisors were significantly retruded and the overjet was decreased compared to the control; moreover,the overjet was unchangeable while the overbite decreased after the peak of growth .4.The soft tissue convexity of UCLP was significantly smaller than the control .On the other hand ,the nasal convexity reduced a lot in the peak of growth. Different from normal, the soft tissue pogonion protruded relatively.