Maxillofacial Plastic and Reconstructive Surgery

  • Volume 42
  • /
  • Pages.8.1-8.5
  • /
  • 2020
  • /
  • 2288-8101(pISSN)
  • /
  • 2288-8586(eISSN)
Korean Association of Maxillofacial Plastic and Reconstructive Surgeons (대한악안면성형재건외과학회)
권호 표지
DOI QR코드

DOI QR Code

Low incidence of maxillary hypoplasia in isolated cleft palate

  • Azouz, Vitali (Department of Surgery, Summa Health System) ;
  • Ng, Marilyn (Plastic, Reconstructive and Hand Surgery, Northwell Health-Staten Island University Hospital) ;
  • Patel, Niyant (Plastic & Reconstructive Surgery, Akron Children's Hospital) ;
  • Murthy, Ananth S. (Plastic & Reconstructive Surgery, Akron Children's Hospital)
  • Received : 2020.02.13
  • Accepted : 2020.03.11
  • Published : 2020.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Background: The cause of maxillary growth restriction in patients with cleft lip and palate remains controversial. While studies have investigated the effects surgical technique and timing have on maxillary growth, few focus on patients with isolated cleft palate (ICP). The purpose of this study was to determine the impact palate repair and its associated complications may have on maxillary growth. Methods: A retrospective chart review of ICP patients who underwent palatoplasty from 1962 to 1999 at Akron Children's Hospital was performed. Patient demographics, Veau type, age at primary repair, closure technique, presence of fistula or velopharyngeal insufficiency (VPI), number of palatal operations, maxillary hypoplasia (MH) frequency, and follow-up were recorded. Exclusion criteria included patients with cleft lip, submucous cleft, or syndromes. Results: Twenty-nine non-syndromic ICP patients were identified; 62% (n = 18) had Veau type 1 and 38% (n = 11) had Veau type 2. All patients underwent 2-flap or Furlow palatoplasty with mobilization of mucoperiosteal flaps. Vomerine flaps were used in all Veau 2 cleft palate closures. Palatoplasty was performed at a mean age of 19.9 ± 8.2 months. Average follow-up was 209 ± 66.5 months. The rate of VPI was 59% (n = 17) and the rate of oronasal fistula was 14% (n = 4). Conclusions: There was a low incidence of MH despite complications after initial palate closure. Our results seem to suggest that age at palate closure, type of cleft palate, and type of surgical technique may not be associated with MH. Additionally, subsequent procedures and complications after primary palatoplasty such as VPI and palatal fistula may not restrict maxillary growth.

Keywords

Acknowledgement

Neil McNinch MS RN- Biostatistician Akron Children's Hospital- statistical analysis Rachel Michael M.D.- Chart review. We thank the follow surgeons for graciously allowing us to access their patient charts: Devi Tantri, James Lewis, Michael Parker, James Lehman, A. Lawrence Cervino, Joseph Ewing, Sol Braver, Michael Bumagin

References

  1. Capelozza L, Taniguchi SM, Silva OG (1993) Craniofacial morphology of adult unoperated complete unilateral cleft lip and palate patients. Cleft Palate Craniofac J 30:376-381
  2. Diah E, Lo LJ, Huang CS, Sudjatmiko G, Susanto I, Chen YR (2007) Maxillary growth of adult patients with unoperated cleft: answers to the debates. J Plast Reconstr Aesthet Surg 60:407-413
  3. Iwasaki H, Kudo M, Yamamoto Y (2009) Does congenital cleft palate intrinsically influence craniofacial morphology? Craniofacial features in unoperated submucous cleft palate children in prepuberty. J Oral Maxillofac Surg 67:477-484
  4. Ortiz-Monasterio F, Alfonso SR, Gustavo BP, Rodriguez-Hoffman HE, Vinageras E (1966) A study of untreated adult cleft palate patients. Plast Reconstr Surg 28:36-41
  5. Ross RB (1969) The clinical implications of facial growth in cleft lip and palate. Cleft Palate J 7:37-47
  6. Ross RB (1987) Treatment variables affecting facial growth in unilateral cleft lip and palate. Part 5: timing of palate repair. Cleft Palate J e24:54-63
  7. Mars M, Houston WJ (1990) A preliminary study of facial growth and morphology in unoperated male unilateral cleft lip and palate subjects over 13 years of age. Cleft Palate J 27:7-10
  8. Capelozza Filho L, Correa Normando AD, da Silva Filho OG (1996) Isolated influences of lip and palate surgery on facial growth: comparison of operated and unoperated male adults with UCL/P. Cleft Palate Craniofac J 33:51-56
  9. Liao YF, Mars M (2005) Long-term effects of clefts on craniofacial morphology in patients with unilateral cleft lip and palate. Cleft Palate Craniofac J a 42:601-609
  10. Kapucu RM, Gursu GK, Enacar A, Aras S (1996) The effect of cleft lip repair on maxillary morphology in patients with unilateral complete cleft lip and palate. Plast Reconstr Surg 97:1371-1375
  11. Li Y, Shi B, Song QG, Zuo H, Zheng Q (2006) Effects of lip repair on maxillary growth and facial soft tissue development in patients with a complete unilateral cleft of lip, alveolus, and palate. J Craniomaxillofac Surg 34:355-361
  12. Chen ZQ, Qian YF, Wang GM, Shen G (2009) Sagittal maxillary growth in patients with unoperated isolated cleft palate. Cleft Palate Craniofac J 46: 664-667
  13. Xu Y, Yang C, Schreuder WH, Shi J, Shi B, Zheng Q et al (2014) Cephalometric analysis of craniofacial morphology and growth in unrepaired isolated cleft palate patients. J Craniomaxillofac Surg 42:1853-1860
  14. Odom EB, Woo AS, Mendonca DA, Huebener DV, Nissen RJ, Skolnick GB et al (2016) Long-term incisal relationships after palatoplasty in patients with isolated cleft palate. J Craniofac Surg 27:867-870
  15. Elander A, Persson C, Lilja J, Mark H (2017) Isolated cleft palate requires different surgical protocols depending on cleft type. J Plast Surg Hand Surg 51:228-234
  16. Graber TM (1949) Craniofacial morphology in cleft palate and cleft lip deformities. Surg Gynecol Obstet 88:359-369
  17. Good PM, Mulliken JB, Padwa BL (2007) Frequency of Le Fort I osteotomy after repaired cleft lip and palate or cleft palate. Cleft Palate Craniofac J 44: 396-401
  18. Oberoi S, Hoffman WY, Chigurupati R, Vargervik K (2012) Frequency of surgical correction for maxillary hypoplasia in cleft lip and palate. J Craniofac Surg 23:1665-1667
  19. Jackson O, Stransky CA, Jawad AF, Basta M, Solot C, Cohen M et al (2013) The Children 's Hospital of Philadelphia modification of the Furlow doubleopposing Z-palatoplasty: 30-year experience and long-term speech outcomes. Plast Reconstr Surg 132:613-622
  20. Timbang MR, Gharb BB, Rampazzo A, Papay F, Zins J, Doumit G (2014) A systematic review comparing Furlow double-opposing Z-plasty and straight-line intravelar veloplasty methods of cleft palate repair. Plast Reconstr Surg 134:1014-1022
  21. Chorney SR, Commesso E, Tatum AS (2017) Incidence of secondary surgery after modified Furlow palatoplasty: a 20-year single-surgeon case series. Otolaryngol Head Neck Surg 157:1-6
  22. Reddy RR, Reddy SG, Vaidhyanathan A, Berge SJ, Kuijpers-Jagtman AM (2017) Maxillofacial growth and speech outcome after one-stage or two-stage palatoplasty in unilateral cleft lip and palate. A systematic review. J Craniomaxillofac Surg 45:995-1003
  23. Rossell-Perry P, Cotrina-Rabanal O, Figallo-Hudtwalcker O, Gonzalez-Vereau A (2017) Effect of relaxing incisions on the maxillary growth after primary unilateral cleft palate repair in mild and moderate cases: a randomized clinical trial. Plast Reconstr Surg Global Open 1:1-8