Maxillary hypoplasia in the cleft patient: contribution of orthodontic dental space closure to orthognathic surgery.
BACKGROUND
Cleft lip and palate surgery in the developing child is known to be associated with maxillary hypoplasia. However, the effects of nonsurgical manipulations on maxillary growth have not been well investigated. The authors present the contribution of orthodontic dental space closure with canine substitution to maxillary hypoplasia and the need for orthognathic surgery.


METHODS
Cleft lip/palate and cleft palate patients older than 15 years of age were reviewed for dental anomalies, orthodontic canine substitution, and Le Fort I advancement. Skeletal relationships of the maxilla to the skull base (SNA), mandible (ANB), and facial height were determined on lateral cephalograms. Logistic regression analyses were performed to estimate odds ratios.


RESULTS
Ninety-five patients were reviewed (mean age, 18.1 years). In 65 patients with congenitally missing teeth, 55 percent with patent dental spaces required Le Fort I advancement. In contrast, 89 percent who underwent canine substitution required Le Fort I advancement (p = 0.004). Canine substitution is associated with a statistically significant increase in maxillary retrognathia when compared with dental space preservation on lateral cephalograms (mean SNA, 75.2 and 79.0, respectively; p = 0.006). Adjusting for missing dentition, logistic regression analyses demonstrated that canine substitution is an independent predictor for orthognathic surgery (OR, 6.47) and maxillary retrusion defined by SNA < 78 (OR, 8.100).


CONCLUSIONS
The coordination of orthodontia and surgery is essential to cleft care. The authors report a strong association between orthodontic cleft closure using canine substitution with maxillary hypoplasia and subsequent Le Fort I advancement, and suggest systematic criteria for management of cleft-related dental agenesis.


METHODS
Therapeutic, III.
Los Angeles, Calif. From the Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine; and Section of Orthodontics, University of California Los Angeles School of Dentistry.
Justine C
JC
Lee
Ginger C
GC
Slack
Ryann
R
Walker
Lindsay
L
Graves
Sandra
S
Yen
Jessica
J
Woo
Rishal
R
Ambaram
Martin G
MG
Martz
Henry K
HK
Kawamoto
James P
JP
Bradley
D000293:Adolescent; D002971:Cleft Lip / Q000150:complications*; D002972:Cleft Palate / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008437:Maxilla / Q000002:abnormalities*; D008844:Micrognathism / Q000628:therapy*; D019516:Orthodontic Space Closure; D056948:Orthognathic Surgical Procedures; D012189:Retrospective Studies; D055815:Young Adult