title: Long-term mid-facial growth of patients with a unilateral complete cleft of lip, alveolus and palate treated by two-stage palatoplasty: cephalometric analysis.
abstract: OBJECTIVE
  The aim of this study is to evaluate long-term facial growth in adults previously treated for an isolated unilateral complete cleft lip, alveolus and palate by two-stage palatoplasty.
  
  
  METHODS
  Unilateral cleft lip and palate (UCLP) patients of 17 years and older treated by two-stage palatoplasty were invited for long-term follow-up. During follow-up, lateral cephalograms were obtained (n = 52). Medical history was acquired from their medical files. Outcome was compared to previously published normal values and the Eurocleft study.
  
  
  RESULTS
  Soft and hard palate closure were performed at the age of 8 (SD 5.9) months and 3 (SD 2.2) years, respectively. The mean maxillary and mandibular angle (SNA, SNB) were 74.9° (SD 4.2) and 75.8° (SD 3.8). Maxillary and maxillomandibular relationships (SNA, ANB) were comparable to all Eurocleft Centres, except for Centre D. We observed a significantly steeper upper interincisor angle compared to the Eurocleft Centres.
  
  
  CONCLUSIONS
  This study describes the long-term craniofacial morphology in adults treated for a UCLP with hard palate closure at a mean age of 3 years. The mean maxillary angle SNA and mandibular angle SNPg were comparable to previous studies both applying early and delayed hard palate closure. The observed upper incisor proclination is likely caused by orthodontic overcorrection in response to the unfavourable jaw relationships. No clear growth benefit of this protocol could be demonstrated.
  
  
  CONCLUSIONS
  The present study shows the long-term craniofacial morphology of UCLP adults after the Utrecht treatment protocol which includes two-stage palate closure.
authors.affiliation: Department of Plastic Surgery, Wilhelmina Children's Hospital, Lundlaan 6, PO Box 85090, 3508 AB, Utrecht, The Netherlands. isabellekappen@me.com.
authors.forename: I F P M
authors.initials: IFPM
authors.lastname: Kappen
authors.affiliation: Department of Maxillofacial Surgery, University Medical Centre Utrecht, Heidelberglaan 100, PO box 85500, 3508 AB, Utrecht, The Netherlands.
authors.forename: G K P
authors.initials: GKP
authors.lastname: Bittermann
authors.affiliation: Department of Methodology and Statistics, University of Utrecht, Padualaan 14, 3584 CH, Utrecht, The Netherlands.
authors.forename: R M
authors.initials: RM
authors.lastname: Schouten
authors.affiliation: Department of Maxillofacial Surgery, University Medical Centre Utrecht, Heidelberglaan 100, PO box 85500, 3508 AB, Utrecht, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Bittermann
authors.affiliation: Department of Maxillofacial Surgery, University Medical Centre Utrecht, Heidelberglaan 100, PO box 85500, 3508 AB, Utrecht, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Etty
authors.affiliation: Department of Maxillofacial Surgery, University Medical Centre Utrecht, Heidelberglaan 100, PO box 85500, 3508 AB, Utrecht, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Koole
authors.affiliation: Department of Plastic Surgery, Wilhelmina Children's Hospital, Lundlaan 6, PO Box 85090, 3508 AB, Utrecht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Kon
authors.affiliation: Department of Plastic Surgery, Wilhelmina Children's Hospital, Lundlaan 6, PO Box 85090, 3508 AB, Utrecht, The Netherlands.
authors.forename: A B
authors.initials: AB
authors.lastname: Mink van der Molen
authors.affiliation: Department of Plastic Surgery, Wilhelmina Children's Hospital, Lundlaan 6, PO Box 85090, 3508 AB, Utrecht, The Netherlands.
authors.forename: C C
authors.initials: CC
authors.lastname: Breugem
mesh_terms: D000293:Adolescent; D002508:Cephalometry; D002971:Cleft Lip / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D002972:Cleft Palate / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008445:Maxillofacial Development / Q000502:physiology*; D055815:Young Adult
keywords: Cephalometry; Facial growth; Long-term results; Two-stage palatoplasty; UCLP