Alveolar Arch Growth Following Palatal Surgery in Cleft Lip/palate

Objectives: To examine changes in width of the maxillary alveolus in a group of subjects with unilateral cleft lip and palate (UCLP), whose lips were repaired by one of two different surgical techniques and palates repaired using one of two different techniques.

Methods: This study is reporting on 303 subjects with UCLP who were enrolled in a prospective randomized clinical trial to assess outcome measures for speech and facial/dental arch growth. Subjects were randomized to: 1) two different surgical lip repair groups (Spina and Millard); and 2) two different palatal surgical groups (von Langenbeck and Furlow double opposing Z-palatoplasty). All lip and palatal surgeries were performed at one center by four surgeons. Dental study models were obtained for all subjects before lip surgery, immediately before palatal surgery and at a visit between 0.5 to approximately 3 years post palatal surgery. The alveolar ridges were outlined and a measurement was made between the left and right tuberosity (TR – TL).

Results: Following lip surgery there was no difference in the TR – TL values between the two procedures. The Spina technique the mean TR – TL value was 35.2 mm (s.d. 3.4) and for the Millard it was 35.8 mm (s.d. 3.1). The mean follow-up time after palatal surgery was 233 days (s.d. 268) for the von Langenbeck and 256 (s.d. 369) for the Furlow procedure. Following palatal surgery the TR – TL values were +0.33 mm (s.d. 2.9) for the von Langenbeck and -0.61 mm (s.d. 2.9) for the Furlow procedure (p = .0085).

Conclusion: With limited follow-up data and a partial sample of the total subject pool, our preliminary results suggest that the two palatal procedures may result in different posterior dental arch growth.

This study was supported by NIH/NIDCR DE0116037.