Facial growth in patients with unilateral cleft lip and palate at 19 years of age after three different one-stage palatal repairs: a longitudinal study with prediction from cephalograms at 5 years of age.

Abstract

Objectives: To compare cephalometric long-term outcomes in patients with unilateral cleft lip and palate (UCLP) and treated with three different surgical protocols for palatal repair. Furthermore, to investigate growth longitudinally and evaluate the possibility to predict the outcome at age 19 from cephalometric values at 5 years.

Materials/methods: Lateral cephalograms of 68 patients, operated according to the Veau-Wardill-Kilner technique (n = 13), the minimal incision technique (n = 39), or MIT with muscle reconstruction (MITmr) (n = 16) were assessed. At a mean age of 19.0 (SD 0.7) years, 17 skeletal and 6 soft tissue variables were analysed using analysis of variance (ANOVA) with pairwise comparison. Lateral cephalograms at a mean age of 5.1 (SD 0.4) years, from 32 of the 68 patients were used to predict values at 19 years, using a multiple linear regression.

Results: There were statistically significant differences between the three surgical techniques for eight of the skeletal variables and for two of the soft-tissue variables at 19 years. The angle between the sella/nasion plane and the nasion/A plane (SNA) was 74.5 (SD 3.8) after Veau-Wardill-Kilner (VWK), 77.6 (SD 5.3) after minimal incision technique (MIT), and 76.7 (SD 2.6) after MITmr. Adjusted for baseline values, at 5 years, only face height had a significant effect dependent on surgical technique.

Limitations: Due to the exclusion criteria or missing medical records, only 43% of 157 consecutive patients could be included in the study.

Conclusion: MIT and MITmr resulted in better cephalometric results regarding facial growth sagittally and vertically compared to VWK. Most of the cephalometric variables measured showed a strong positive relation between the value at 5 and the value at 19 years of age.