Two-stage palate repair with delayed hard palate closure is related to favorable maxillary growth in unilateral cleft lip and palate.
BACKGROUND
Two-stage palate repair with delayed hard palate closure is generally advocated because it allows the best possible postoperative maxillary growth. Nevertheless, in the literature, it has been questioned whether maxillary growth is better following use of this protocol. The authors therefore aimed to investigate whether stage of palate repair, one-stage versus two-stage, had a significant effect on facial growth in patients with unilateral cleft lip and palate.


METHODS
Seventy-two patients with nonsyndromic complete unilateral cleft lip and palate operated on by two different protocols for palate repair, one-stage versus two-stage with delayed hard palate closure, and their 223 cephalometric radiographs were available in the retrospective longitudinal study. Clinical notes were reviewed to record treatment histories. Cephalometry was used to determine facial morphology and growth rate. Generalized estimating equations analysis was performed to assess the relationship between (1) facial morphology at age 20 and (2) facial growth rate, and the stage of palate repair.


RESULTS
Stage of palate repair had a significant effect on the length and protrusion of the maxilla and the anteroposterior jaw relation at age 20, but not on their growth rates.


CONCLUSIONS
The data suggest that in patients with unilateral cleft lip and palate, two-stage palate repair has a smaller adverse effect than one-stage palate repair on the growth of the maxilla. This stage effect is on the anteroposterior development of the maxilla and is attributable to the development being undisturbed before closure of the hard palate (i.e., hard palate repair timing specific).
Liao
Yu-Fang
YF
Taipei and Taoyuan, Taiwan From the Craniofacial Center, Chang-Gung Memorial Hospital, and the College of Medicine, Chang Gung University.
Yang
I-Ying
IY
Wang
Ruby
R
Yun
Claudia
C
Huang
Chiung-Shing
CS
D000293:Adolescent; D002508:Cephalometry; D002648:Child; D002675:Child, Preschool; D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D005260:Female; D006801:Humans; D007574:Jaw Relation Record; D008297:Male; D008437:Maxilla / Q000254:growth & development*; D008445:Maxillofacial Development / Q000502:physiology; D019647:Oral Surgical Procedures / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult