Abstract
The purpose of the present study is to clarify the effect of two-stage palatal closure by our own technique based on Perko's technique, to maxillary growth in comparison with that of the ordinary palatal pushback operation in patients with complete unilateral cleft lip and palate. After lip repair by Tennison's method at age 5 months, one group of 14 patients (Group I) received an ordinary palatal pushback operation at age 20 months. Another group of 16 patients (Group II) received the two-stage palatal closure in which the primary veloplasty, was performed at age 20 months, with the dissection of supraperiosteal mucosal flaps from the posterior half of the hard palate and with simultaneous posterior transposition and muscle union in the soft palate. Then, the hard palate closure was performed at age 6 years. The children were studied at age 5 months (stage A; prior to lip repair), at age 20 months (stage B; prior to primary palatoplasty), at age 4 years (stage C), and at age 6 years (stage D; 2 months after the hard palate closure in Group II).
A longitudinal and three dimensional maxillary growth was monitored by the measureme n t of the maxillofacial cast models obtained from each of the patients. Non-cleft subjects (Control group) were also classified into four stages to match the cleft groups by age and body weight.
Results obtained were as follows;
1. Though the morphological feature in the cleft groups was remarkable at stage A, the difference was mainly because of the segmental displacements and there was no significant difference in the forward and the downward growth of the maxilla between the cleft groups and the control group. The remarkab le inhibition in the forward and the downward growth of the maxilla especially occurred at th e anterior alveolar region after lip repair in both of the cleft groups at stage B.
2. The maxillary growth difference between the cleft groups of I and II became distinctive after the primary palatoplasty. The inhibition in the forward and the downward growth which occurred after the lip rapair was able to be compensated in the Group II by the catch-up growth in the subsequent stages whi ch resulted in no significant difference compared to the control group at stage D. However, this didn't occur in Group I.
3. The remaining cleft of the hard palate after the primary veloplasty in Group II showed narrowing in its size along with the growth of the palatal shelves.
4. The multivariate analysis on the dental occlusion between the cleft groups of I and II at stage D showed that the difference in occlusion was notable in the incisor relation as shown in the trends of edge-to -edge in Group II and of the crossbite in the Group I.
