Craniofacial Growth Characteristics In Patients With With Repaired Cleft Lip And Palate

Cheilopalatognathus is a common maxillofacial deformity in neonates. The orthodontic treatment is an indispensable part of serial treatment. Some studies have found that patients with cheilopalatognathus would be high risk of delayed cervical vertebral maturation compared with age-matched no-cleft groupe. Therefore, the traditional age-matched comparison research made by most scholars at home and abroad may be limited.Currently, there are many researches about the craniofacial development in patients with cleft lip and palate. However, due to different surgical repair time and different type of cheilopalatognathus, the development features are not obvious for cheilopalatognathus patients’ skull base, maxillary vertical development and mandibular. Meanwhile, less researches of their development regular pattern are made. Because of shorted development of maxillary sagittal development, most cleft lip and palate patients show class III malocclusion tendency. However, there are few studies on the features of cheilopalatognathus patients in different development periods and Angle Class III patients with healthy people.In order to better understand the characteristics of craniofacial development in patients with cleft lip and palate, we studied the craniofacial development regularity of patients with cleft lip and palate. CVM staging method was used in this experiment, which is more representative than physiological age method. Researches may provide reference for the treatment of patients with cleft lip and palate.50 patients with repaired UCLP(complete unilateral cleft lip and palate) and 28 patients with UCL(complete unilateral cleft lip) were included in this study. This research also randomly selected 50 patients with class I malocclusion or classs III malocclusion from large sample as the control group. All of subjects divided into three groups according to their cervical vertebral maturation respectively. Lateral cephalograms of all subjects were obtained by software of winceph 8.0. The data were analyzed and compared by PRISM 6.0.The results of this study include the following three aspects:Part I : A preliminary study on the craniofacial growth rules in patients with repaired cleft lip and palateThe main comparison results of different development stages of UCLP patients are as follows: The indexes of face height(N-Me),mandibular body length(Go-Gn),the mandibular length(Co-Gn) had increases of 7.13 mm, 7.23 mm, 8.45 mm respectively, comparing CS3、4 to CS1、2, which showed statistical difference. The indexes of lower facial height(ANS-Me), mandibuar ruma height(Co-Go), mandibular length(Co-Gn) had an increase of 4.80 mm, 3.85 mm, 8.45 mm, comparing CS5、6 to CS3、4, which had statistical difference.While the indexes of maxilla length and location(SNA,ANB,ANS-PNS,U1-U6) showed no statistical difference among groups.The main comparision results of the UCL patients from different development groups are as follows: The indexes of face height(N-Me), the mandibular length(Co-Gn) had increases of 9.46 mm, 8.28 mm, comparing CS3、4 to CS1、2 stage. The mandibuar ramus height(Co-Go) had an increase of 5.53 mm, which also showed statistical difference. The index of mandibular body length(Go-Gn) had a gradually increase of 5.55 mm comparing CS5、6 to CS1、2, which showed statistical difference. While the indexes of maxillary length and maxillary location(SNA,ANB,ANS-PNS,U1-U6) showed no statistical difference among different development groups.Part II : The difference of Craniofacial growth characteristics between patients with repaired cleft lip and palate and patients with angle I malocclusionIn CS1、2 stage, the maxillary position of UCLP patients was relatively behind of skull base comparing to the class I patients,with a reduce of 6.83° in SNA angle. The sagittal basal length of maxillary bone(ANS-PNS), the sagittal length of the alveolar( U1-U6) had reduces of 1.86 mm and 4.17 mm respectively in UCLP patients. SN-PP had an increase of 4.12 degrees. In CS3、4 stage, these differences were more apparent. SNB and SND of UCLP patients were smaller than those of Class I patients generally. In CS1、2 stage, Co-Go of UCLP patients was statistically smaller by 3.97 mm than that of Class I patients, then statistical difference still existed in CS3、4 and CS5、6 stages.The sagittal position and the size of maxilla and mandible in UCL patients had no statistically difference with class I patients. However, the indexes of upper and lower front teeth labial inclination of UCL patients were smaller by 6.23° and 3.90° respectively than those of class I patients, having statistically significant. The soft tissue measurements of Z angle and the protrusion of lower lip were bigger in UCL patients.The indexes of maxillary position in UCLP patients, such as SNA and ANB, were smaller in every development stage,when coparing with those of the UCL patients. The maxillary sagittal length(ANS-PNS) of UCLP patients was statistically smaller by 3.58 mm than that of UCL patients. The indicators of the vertical development of the maxilla(N-ANS, U6-PP) had no statistical difference between the different cleft groups. The anterior alveolar height(U1-PP) of UCLP patients were statistically smaller than UCL and class I patients in CS5、6 stage.Part III : The difference of craniofacial growth characteristics between patients with repaired cleft lip and palate and patients with angle III malocclusionThe main comparison results of UCLP patients with class III patients were shown as follows. In CS1、2 stage,the indexes of SNB, SNA, SND, Go-Gn, Co-Gn and U1-SNwere statistically smaller in UCLP patients by 4.47°, 6.20°, 5.43°, 2.04 mm, 5.64 mm, 7.18° respectively. In CS5、6 stage, the difference was more obvious than that in CS1、2 stage, with the reduced value that SNA(4.55), SNB(5.76), SND(4.71), Go-Gn(3.43), Co-Gn(3.05), U1-SN(11.78).The main comparison results of UCL patients with class III patients were shown below. In CS1、2 stage, the indexes of ANB, WITS of UCL patients were statistically smaller by 3.37 degrees, 5.29 mm respectively. The diffrences still existed in CS3、4 and CS5、6 stage. The indexes of SNB, SND, Go-Gn, Co-Gn were smaller in UCL patients in CS1、2 stage, withnot statistically significant.However, in CS3、4 and CS5、6 phase, the differences gradually had statistical significance.Conclusions: 1.Patients aged from 8-20 with cleft lip and palate, of which maxillary development may not be obvious, the mandibular size may increased obviously. 2.The development features of UCLP patients may differed from those of UCL patients in some degree, and the differences were mainly in the indexes which indicate maxillary sagittal development. 3. The UCLP patients showed sagittal maxillary hypoplasia compared with class I patients, While the alveolar sagittal length was insufficient and the anterior alveolar vertical development was insufficient. Because of the maxillary limitation, the mandibular retrusion was existed. The mandibular ramus of UCLP patients was shorter and the mandibular plane angle(MP-FH) was steeper. Compared with class III patients, the mandible of UCLP patients was in the back position, the mandibular body lenth was shorter. However, the relative location of maxilla and mandible and the palatine sagittal length may be similar with class III patients in UCLP patients. 4. The position and size of maxilla and mandible of UCL patients may be similar with those of class I patients, but the Labial inclination of anterior teeth, the Li-Sn Pg, and the Z angle may be different from those of class I patients.