Intrinsic maxillary deficiency in infants with complete unilateral cleft of the lip and palate
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Abstract
Background: Approximately 1 in 700 live births results in a child born with a cleft lip and palate. While ethnic predilection and gender differences exist, cleft lip and palate remains the most common congenital malformation of the head and neck. Although the etiology of UCLP is multifactorial in nature, the end result remains the same: an open communication or cleft. Patients born with UCLP are best managed early and in an interdisciplinary manner. Cleft palate teams are formed even prior to the birth of the child so that appropriate care and patient management can be initiated with precise timing and sequencing. With the advent of digital models and computed surface area analysis, prediction of outcome in conjunction with scientifically-based medical treatments can provide the best prognosis.
Though many studies have explored the resulting dental and midface deficiencies of patients with UCLP from a surgical repair standpoint, there have been few studies addressing the intrinsic palatal tissue factor in these patients. Reduced intrinsic palatal tissue in patients with UCLP could indicate a tendency for growth deficiencies that may alter the choice and timing of surgical intervention. Therefore, palatal surface area measurements will provide valuable numerical data assessing the cleft severity and its intrinsic role.
Material and Methods: The sample included 22 maxillary UCLP casts from NYU Langone Medical Center and 37 maxillary casts from infants without clefts from Sillman's longitudinal study. The two groups were matched for age which ranged from 2 days to 4 months. After scanning, Checkpoint™ software (Stratovan, Davis, CA) was used to measure the palatal surface area of each cast. Greater and lesser segments were measured independently on UCLP casts. A total palatal surface area for the UCLP sample including the cleft was also measured.
Statistical Analysis: Descriptive statistics and comparison of total surface area measurements between two samples using independent samples t-tests were performed.
Results: We found that there is a statistically significant difference between UCLP + cleft area and the non-cleft samples in surface area at alpha 0.05 with (P[less than]0.001). Likewise, when we compared UCLP area of the segments alone with the non-cleft samples there was a statistically significant difference in surface area at alpha 0.05 with (P[less than]0.0001). The mean total surface area was 801.88mm2 ± 79.90 for the non-cleft sample, 916.51mm2. 2 ± 177.07 for the total surface area+ cleft area in the UCLP sample, and 608.10mm ± 113.31 for the total surface area - cleft area in the UCLP sample. These means demonstrated statistically significant differences amongst the two groups (p[less than]0.05). Mean surface area measurements for the greater and lesser segments also showed statistically significant differences at 359mm2 ± 74.49 for the greater segment and 249.l mm2 ± 55.15 for the lesser segment.
Conclusion: The statistically significant results from this study show that an intrinsic tissue deficiency exists in patients born with UCLP. The results of this study give cleft teams and families a better initial understanding of the intrinsic tissue deficiency which exists in children born with UCLP. Therefore, careful attention should be given to the repair technique and timing ofUCLP to minimize surface area reduction when the greater and lesser segments are protracted since an intrinsic tissue deficiency exists.
Description
Thesis (MSD) --Boston University, Henry M. Goldman School of Dental Medicine, 2015 (Department of Orthodontics and Dentofacial Orthopedics).
Includes bibliographic references: leaves 25-29.
Includes bibliographic references: leaves 25-29.
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This work is being made available in OpenBU by permission of its author, and is available for research purposes only. All rights are reserved to the author.