Effect of lip closure on early maxillary growth in patients with cleft lip and palate

摘要

IMPORTANCE Debate continues about the cause of midfacial growth disturbance in patients with facial clefts. OBJECTIVE To evaluate the functional effect of surgical closure of the lip before palatal closure according to the technique by Delaire on early maxillary growth in patients with complete unilateral cleft lip and palate. DESIGN, SETTING, AND PARTICIPANTS Twenty-two patients with unilateral cleft lip and palate were studied using plaster casts obtained at the time of cheilorhinoplasty and 6 months later before palatal closure. The interrupted lateral muscles were anatomically repositioned using the surgical technique by Delaire. No patients had received preoperative orthodontic treatment or a passive palatal plate. Cast analyses were performed using a digital caliper. MAIN OUTCOMES AND MEASURES Landmark positioningwas performed 3 times by 2 different examiners to define intraobserver and interobserver differences. The final maxilla dimensions were recorded as the distances between the mean landmark positions. Using the t test, dimensions obtained before palatal closure were compared with dimensions obtained before lip closure. RESULTS Themethod allowed good reproducibility. Functional closure of the lip significantly narrowed the transverse anterior cleft areas by -2.36mm(P < .05). Sagittal variables were increased by 1.68mmon the nonaffected side and by 1.48mmon the affected side (P < .05 for both). CONCLUSIONS AND RELEVANCE Functional closure according to the technique by Delaire narrows the transverse dimensions of the maxilla, while simultaneously preserving initial sagittal growth. LEVEL OF EVIDENCE 4.