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ITALIAN JOURNAL OF MAXILLOFACIAL SURGERY
Rivista di Chirurgia Maxillo-Facciale
Official Journal of the Italian Society of Maxillofacial Surgery
Italian Journal of Maxillofacial Surgery 2009 August;20(2):89-94
Factors affecting variability in maxillary growth impairment in cleft and lip and palate patients treated with the same surgical protocol
Ventrini F. 1, Meazzini M. C. 2, Tortora C. 1, Morabito A. 3, Garattini G. 1, Brusati R. 2
1 Department of Orthodontics, S.Paolo Hospital, Milan, Italy
2 Regional Center for CLP, Department of Maxillo-Facial Surgery, S. Paolo Hospital, Milan, Italy
3 Department of Biostatistics, S.Paolo Hospital, Milan, Italy
Aim. No true consensus exists regarding the causes of maxillary growth restriction in cleft and lip and palate (CLP) patients. The aim of this study was to try to identify causes of this growth impairment, other than the influence of surgical technique and skill. We analyzed a sample of 129 consecutively treated 5 year old UCLP patients, operated by the same surgeon with the same surgical protocol.
Methods. Multiple cephalometric measurements of the sample revealed a wide distribution of maxillary growth values. We selected SNA as a value describing maxillary position. Parameters investigated to search for different influencing factors within the groups were: initial cast measurements, timing of lip and of gingivo-alveolo-plasty (GAP)/palatal surgery, presence of permanent lateral incisors and family history of maxillary hypoplasia. Statistical differences were investigated with a Pearson Correlation and with an ANOVA.
Results. The factor most significantly linked to maxillary protrusion was the presence or absence of the permanent lateral incisor, even when peg laterals and supernumerary laterals were considered. Timing of lip surgery was mildly, but not significantly correlated to SNA. Initial palatal width measured on infant casts was correlated to maxillary growth. Surgical timing of GAP was not correlated.
Conclusion. Although surgical skill and technique may be the most important factors responsible for maxillary growth impairment, inherent tissue hypoplasia, possibly represented by the lack of lateral incisors and by the initial posterior width of the palatal cleft, seem to be the most important non iatrogenic factors.