title: Effect of lip closure on early maxillary growth in patients with cleft lip and palate.
abstract: OBJECTIVE
  Debate continues about the cause of midfacial growth disturbance in patients with facial clefts.
  
  
  OBJECTIVE
  To evaluate the functional effect of surgical closure of the lip before palatal closure according to the technique by Delaire on early maxillary growth in patients with complete unilateral cleft lip and palate.
  
  
  METHODS
  Twenty-two patients with unilateral cleft lip and palate were studied using plaster casts obtained at the time of cheilorhinoplasty and 6 months later before palatal closure. The interrupted lateral muscles were anatomically repositioned using the surgical technique by Delaire. No patients had received preoperative orthodontic treatment or a passive palatal plate. Cast analyses were performed using a digital caliper.
  
  
  METHODS
  Landmark positioning was performed 3 times by 2 different examiners to define intraobserver and interobserver differences. The final maxilla dimensions were recorded as the distances between the mean landmark positions. Using the t test, dimensions obtained before palatal closure were compared with dimensions obtained before lip closure.
  
  
  RESULTS
  The method allowed good reproducibility. Functional closure of the lip significantly narrowed the transverse anterior cleft areas by -2.36 mm (P < .05). Sagittal variables were increased by 1.68 mm on the nonaffected side and by 1.48 mm on the affected side (P < .05 for both).
  
  
  CONCLUSIONS
  Functional closure according to the technique by Delaire narrows the transverse dimensions of the maxilla, while simultaneously preserving initial sagittal growth.
  
  
  METHODS
  4.
authors.affiliation: Department of Oral, Maxillofacial, and Facial Plastic Surgery, University of Freiburg, Freiburg, Germany2Department of Plastic, Aesthetic, and Reconstructive Surgery, Centre Hospitalier Universitaire, Angers, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Rousseau
authors.forename: Marc
authors.initials: M
authors.lastname: Metzger
authors.forename: Sibylle
authors.initials: S
authors.lastname: Frucht
authors.forename: Wipke
authors.initials: W
authors.lastname: Schupp
authors.forename: Mareike
authors.initials: M
authors.lastname: Hempel
authors.forename: Jörg-Elard
authors.initials: JE
authors.lastname: Otten
mesh_terms: D059925:Anatomic Landmarks; D002508:Cephalometry; D002971:Cleft Lip / Q000503:physiopathology / Q000601:surgery*; D002972:Cleft Palate / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008046:Lip / Q000601:surgery*; D008297:Male; D008437:Maxilla / Q000254:growth & development*; D015588:Observer Variation; D019651:Plastic Surgery Procedures / Q000379:methods*; D015203:Reproducibility of Results; D012225:Rhinoplasty; D016896:Treatment Outcome