Maxillary Structure of Infants with Unilateral Clefts Lip and Alveolus Immediately after Presurgical Orthopedics and Gingivoperiosteoplasty

―3D Analysis Using CT Images―

Abstract

 Recently, more centers are performing gingivoperiosteoplasty（GPP）to achieve early cleft closure for infants with cleft lip and palate. In many cases, presurgical infant orthopedics（PIO）must be performed prior to GPP for the molding of alveoli. However, some studies suggest that PIO and GPP cause narrowing of the maxillary arch and suppress maxillary growth. Therefore, the three-dimensional morphology of the maxilla was evaluated by analyzing computed tomography（CT）images obtained immediately after PIO and GPP in infants with complete unilateral cleft lip and alveolus（UCLA）. To compare the values of UCLA, CT images were also taken from age-matched infants with incomplete UCLA and infants without clefts.
 CT images of infants with complete and incomplete UCLA who underwent primary surgery at Kanagawa Children’s Medical Center were taken under sedation at 2 weeks postoperatively. All infants with complete UCLA（n = 24）underwent simultaneous GPP and cheiloplasty as the primary surgery after PIO（Group A）. The infants with incomplete UCLA（n = 11）did not undergo PIO; only cheiloplasty was performed as the primary surgery（Group B）. The anteroposterior length, vertical position, and transverse width of the maxilla and the lateral deviation of the anterior nasal spine were three-dimensionally measured in the CT images. CT images were taken from 25 age-matched infants with otitis media and used for references.
 There were no significant differences in the anteroposterior length, vertical position, or transverse width of the maxilla between groups A and B. The lateral deviation of the anterior nasal spine was significantly larger in Group A than in Group B.
 These findings suggest that PIO was not likely to cause narrowing or shortening of the maxilla in infants with complete UCLA immediately after surgery.