Facial Growth at 5 and 10 Years After Veau-Wardill-Kilner Versus Minimal-Incision Technique Repair of Isolated Cleft Palate.

OBJECTIVE: To compare the Veau-Wardill-Kilner technique with the Minimal-Incision technique repair of isolated clefts of the hard and soft palate regarding facial growth at 5 and 10 years of age. DESIGN: Retrospective study of lateral cephalograms. SETTING: Hospital and university based. PATIENTS: A consecutive series of 145 Caucasian nonsyndromic children born with isolated cleft palate between 1980 and 1996 were studied. Children with Pierre Robin sequence (PRS) were included in the study. The patients were divided into 4 groups: 2 groups regarding surgical technique and 2 groups regarding cleft length. INTERVENTION: Veau-Wardill-Kilner or Minimal-Incision palatoplasty. MAIN OUTCOME MEASURES: Eleven skeletal and 1 soft tissue measurement were evaluated from lateral cephalograms taken at 5 and 10 years of age. RESULTS: Only minor differences in cephalometric morphology were found between the Veau-Wardill-Kilner technique group and the Minimal-Incision technique group. Similar results were found independent of cleft length or the inclusion of PRS in the sample. CONCLUSION: The craniofacial cephalometric morphology at 5 and 10 years of age in patients with isolated cleft palate is similar between the Veau-Wardill-Kilner and the Minimal-Incision technique group.

Minimal incision palatoplasty with or without muscle reconstruction in patients with isolated cleft palate: a cast and medical records analysis.

Objectives: To compare the minimal incision (MI) technique with the minimal incision including muscle reconstruction (MMI) technique regarding surgical complications and dentoalveolar status at 5 years of age. Subjects and method: A consecutive series of 202 Caucasian non-syndromic children (apart from Pierre Robin Sequence) born with isolated cleft palate between 1987 and 2007 and treated with MI (n = 78) or MMI (n = 102) palatoplasty at a mean age of 12.7 (SD = 1.43) months in Stockholm. Twenty-two patients did not fulfill the inclusion criteria. The patients were divided into two subgroups: clefts within the soft palate only (small cleft, n = 50) and clefts within the hard and soft palate (big cleft, n = 130). Dental relations, structure of the palatal mucosa, and height of the palatal vault at 5 (mean age 5.3, range: 4.4-6.9) years of age were studied using plaster models. Time for surgery, blood loss, complications in the immediate postoperative period, frequency of fistulas, and additional pharyngeal flap surgery were evaluated. Student's t-test, chi-square test and 95 per cent confidence intervals were calculated. Results: MMI compared to MI technique result in statistically significant increased operation time, less need for pharyngeal flap surgery, and to shallower palatal vault. Big clefts result in statistically significant increased operation time and need for pharyngeal flap surgery. Dental relations were the same in all groups. Limitations: Retrospective single centre study, limited sample size, more than one surgeon. Conclusions: The muscle reconstruction results in a reduced subsequent need for pharyngeal flap surgery, but to shallower palatal vault and demand for almost double operation time. The dental relations were the same in all groups.

The influence of the initial width of the cleft in patients with unilateral cleft lip and palate related to final treatment outcome in the maxilla at 17 years of age.

The aim of this study was to assess whether the initial cleft width in patients born with complete unilateral cleft lip and palate (UCLP), is correlated to final treatment outcome regarding maxillary growth. This report is a retrospective longitudinal cohort study of 45 consecutive non-syndromic individuals with UCLP, 19 from the Stockholm Cleft Team, and 26 from the Oslo Cleft Team. The treatment protocols in the two teams differed. The initial transversal width in infants was measured at three levels on study casts. The width was correlated to variables obtained from lateral cephalograms at 17 years of age, from rating of dental arch relationship and to treatment variables obtained from the medical records: existence of Simonart's band, missing maxillary teeth, duration of orthopaedic/orthodontic treatment, and the need for orthognathic surgery. The initial width of the middle part of the cleft and final maxillary inclination (NSL/NL) showed a weak correlation (P < 0.05); the wider the cleft, the less the inclination. No further correlations were found between the initial width and final outcome measurements studied. In the Oslo group where Simonart's band was present, the anterior and middle widths of the cleft were significantly smaller (P < 0.001). Additionally, the existence of Simonart's band had a significant effect on final maxillary inclination (P < 0.05), i.e. the maxillary inclination increased. Treatment outcome seems mainly to depend on the treatment protocol performed rather than the severity of the cleft. The width of the middle part of cleft may be associated with the final maxillary inclination.

Length of the cleft in relation to the incidence of hypodontia of the second premolar and to inheritance of cleft lip and palate in children with isolated cleft palate.

We studied severity of the isolated cleft palate expressed as the length of the cleft in relation to hypodontia in the second premolar regions and known inheritance of any type of cleft lip and palate. The material consisted of 47 children at 10 years of age born with non-syndromic isolated cleft palate of varying extent, who all had hypodontia of at least one second premolar, and had panoramic radiographs taken at 10 years of age. Information about length of cleft and inheritance of cleft lip and palate was collected from surgical files initiated at birth. The higher the number of missing second premolars, the more extended was the length of the cleft. More children had hypodontia of the second premolar in the mandible than in the maxilla. The family history had little influence on the length of the cleft.

The relationship between hypodontia in the second premolar region and heredity of cleft, lip and palate in children with isolated cleft palate.

The aim of the investigation was to study the relationship between hypodontia in the second premolar region and heredity of cleft lip and palate (CLP) in children with isolated cleft palate (CP). The following null-hypothesis was tested: The heredity for CLP will not give rise to higher prevalence of hypodontia in the second premolar region of the maxilla and the mandible in CP-patients. The material consisted of 188 children born with non-syndromic CP (77 boys and 111 girls). Surgical files initiated at birth and panoramic radiographs at ten years of age have been studied concerning heredity for CLP and hypodontia of second premolars. For all CP-children, irrespective of hereditary background the prevalence of second premolar hypodontia did not differ significantly. However, there was a tendency to higher prevalence of hypodontia of the lower second premolars. The null-hypothesis: The heredity for CLP will not give rise to higher prevalence of hypodontia in the second premolar region of the maxilla and the mandible in CP-patients was not rejected.

Dental occlusion after Veau-Wardill-Kilner versus minimal incision technique repair of isolated clefts of the hard and soft palate.

OBJECTIVE: To compare the Veau-Wardill-Kilner technique with a technique similar to the minimal incision technique described by Mendosa et al. on the basis of surgical complications and dentoalveolar status in the deciduous dentition. DESIGN: Retrospective study of medical and dental records and casts. PATIENTS: A consecutive series of 129 Caucasian children born with isolated cleft palate between 1980 and 1992. MAIN OUTCOME MEASURES: From medical records, the variables of time for surgery, blood loss, complications in the immediate postoperative period, and frequency of fistulas were evaluated. On dental casts, the variables of sagittal, transversal, and vertical relations; structure of the palatal mucosa; and height of the palatal vault were studied. RESULTS: Time for surgery was shorter in the extensive clefts repaired with a Veau-Wardill-Kilner technique. Blood loss was higher using the Veau-Wardill-Kilner technique. The width of the upper jaw was significantly narrower in the Veau-Wardill-Kilner group, compared with the minimal incision group. Scar tissue and pits of the palate were more frequently found in the Veau-Wardill-Kilner group. CONCLUSIONS: The minimal incision technique in this study has been shown to result in better development of the upper jaw with a better dental occlusion and palatal mucosa with significantly less scar tissue.