Six-year post-surgical evaluation in the treatment protocols in the dental arches of children with oral cleft: longitudinal study

To evaluate and compare the development of the dental arches of children with unilateral cleft lip and palate before and after the primary surgeries performed with different techniques at the first months and six years of life.

Methodology

This is a retrospective longitudinal study. The sample comprised 56 dental casts divided int the following groups: Group 1 (G1) – cheiloplasty (Millard technique) at three months and one-step palatoplasty (von Langenbeck technique) at 12 months; and Group 2 (G2) – cheiloplasty (Millard technique) and two-step palatoplasty: anterior hard palate closure (Hans Pichler technique) at three months and posterior soft palate closure (Sommerlad technique) at 12 months. The digitized dental casts were evaluated at three months – pre-surgical (T1) and six years of life– post-surgical (T2). The following linear measurements were analyzed: intercanine (C–C’), intertuberosity (T–T’) distances; anterior dental arch (I–CC’), anterior intersegment (I–C’), and total arch (I–TT’) lengths. The palate area was also measured. Parametric and non-parametric tests were applied (p<0.05).

Results

In G1, the intragroup comparison showed statistically significant smaller I–CC’ and I–C’ at T2 (p=0.001 and p<0.001, respectively), while T–T’, I–TT’, and area comparisons were significantly greater (p<0.001, p=0.002, and p<0.001, respectively). In G2, the intragroup comparison exhibited statistically significant smaller C–C’ and I–C’ at T2 (p=0.004, for both), whereas T–T’, I–TT’ and area comparisons were significantly greater (p<0.001, p=0.004, and p<0.001, respectively). At T2, the intergroup analysis revealed that G1 had a statistically significant smaller I–CC’ (p=0.014). The analysis of the intergroup differences (∆=T2–T1) showed that G1 had a statistically smaller I–CC’ (p=0.043).

Conclusion

The two-step palatoplasty showed a more favorable prognosis for the maxillary growth than one-step palatoplasty in children with oral clefts.

Cleft lip; Cleft palate; Surgeons; Dental arch; Imaging, three-dimensional

Variables	T1, Mean/ Median (SD/ IA)	T2, Mean/ Median (SD/ IA)	P-value
C – C’	29.61 (5.73)^†	25.64 (4.15)^†	0.104^‡
I – CC’	6.83 (0.91)	4.31 (2.14)	0.001
I – C’	19.38 (3.13)	12.22 (2.11)	<0.001
T – T’	37.56 (4.72)^†	46.36 (5.41)^†	<0.001^‡
I – TT’	25.07 (1.47)	29.2 (3.88)	0.002
Area	837.66 (161.68)^†	1274.89 (206.15)^†	<0.001^‡

Variables	T1, Mean/ Median (SD/ IA)	T2, Mean/ Median (SD/ IA)	P-value
C – C’	27.9 (2.95)	25.55 (2.75)	0.004^*
I – CC’	6.76 (1.32)	6.07 (1.30)	0.252
I – C’	18.2 (3.99)	13.22 (1.02)	0.004^†*
T – T’	36.07 (2.14)	43.33 (3.67)	<0.001^*
I – TT’	25.4 (3.17)	29.26 (3.73)	0.004^*
Area	860.12 (148.10)	1156.98 (158.37)	<0.001^*

Variables	T1, P-value	T2, P-value
C – C’	0.800^§	0.495
I – CC’	0.870	0.014
I – C’	0.287	0.323^§
T – T’	0.730^§	0.057
I – TT’	0.727	0.966
Area	0.906	0.147^§

Variables	G1, Mean (SD)	G2, Mean (SD)	P-value
C – C’	1.92 (4.01)	-2.34 (2.59)	0.741
I – CC’	2.51 (2.41)	-0.68 (2.14)	0.043
I – C’	7.16 (4.04)	-4.59 (4.61)	0.130
T – T’	10.39 (3.45)	7.26 (4.66)	0.053
I – TT’	4.13 (4.05)	3.86 (4.24)	0.866
Area	421.64 (261.33)	296.86 (207.13)	0.173

Faculdade De Odontologia De Bauru - USP Serviço de Biblioteca e Documentação FOB-USP, Al. Dr. Octávio Pinheiro Brisolla 9-75, 17012-901 Bauru SP Brasil, Tel.: +55 14 32358373 - Bauru - SP - Brazil
E-mail: jaos@usp.br

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[1] Corresponding address: Thais Marchini Oliveira. Universidade de São Paulo - Faculdade de Odontologia de Bauru - Departmento de Odontopediatria - Ortodontia e Saúde Coletiva - Alameda Dr. Octávio Pinheiro Brisolla, 9-75 - Bauru - São Paulo - 17012-901 - Brasil. Phone: +55 14 3235-8224 e-mail: marchini@usp.br