Development of the palate in patients with complete unilateral cleft lip and palate following cheiloplasty with primary periosteoplasty: 3D geometric morphometric study
Jana Velemínská 1,2, Martina Drábková 1, Eva Hoffmannová1,
Václav Krajíček3, Jiří Borský4
1Charles University, Faculty of Science, Department of Anthropology and Human
Genetics, Prague, Czech Republic
2University of South Bohemia, Faculty of Health and Social Sciences, Institute of
Physiotherapy and Selected Medical Disciplines, České Budějovice, Czech Republic
3Charles University, Faculty of Mathematics and Physics, Department of Software and
Computer Science, Prague, Czech Republic
4Charles University, Faculty Hospital Motol, Department of Otorhinolaryngology 2nd
Faculty of Medicine, Prague, Czech Republic
Korespondenční autor: Jana Velemínská (velemins@natur.cuni.cz)
ISSN 1804-7181 (On-line)
Full verze:
Submitted:3. 5. 2018
Accepted: 25. 5. 2018
Published online: 30. 6. 2018
Summary
The aim: (1) to analyze the growth of cleft palate in patients with complete unilateral cleft of the lip and palate (cUCLP) after cheiloplasty with primary periosteoplasty, and (2) to compare the results with published data of younger cUCLP patients after neonatal cheiloplasty. Materials and methods: The study deals with the longitudinal growth changes of the palate, including alveolar segments and its variability within the analysed group of 14 patients with cUCLP. Twenty eight dental plaster casts obtained from each patient in the two examinations (before cheiloplasty and before palatoplasty) were used for the analysis. The first dental plaster cast was taken from patients with an average age of 8.5 months, while the average age for second continuous casting was 4.5 years. Dental casts were scanned using a 3D laser scanner and then analysed, using methods of geometric morphometrics. Results: Palatal morphology did not differ significantly between the sexes, but a statistically significant growth of palate was detected. A detailed colour-coded map identified the most marked growth at the anterior and posterior ends of both segments. Growth insufficiency of the smaller upper jaw segment after cheiloplasty with periosteoplasty was detected. Conclusion: The reconstructed lip of both compared groups (neonatal and later cheiloplasty) exerts a natural formative effect on the actively growing anterior parts of split segments, which grow towards each other. But on top of that, neonatal cheiloplasty has many other benefits (wound healing, feeding facilitation, socialization), and so it is the most common surgical approach in the Czech Republic now.
Keywords: orofacial cleft; cheiloplasty with periosteoplasty; neonatal lip suture; geometric morphometrics; growth of palate
Literatura
1. Bejdová Š, Krajíček V, Peterka M, Trefný P, Velemínská J (2012). Variability in palatal shape and size in patients with bilateral complete cleft lip and palate assessed using dense surface model construction and 3D geometric morphometrics. J Craniomaxillofac Surg. 40/3: 201–208.
2. Borský J, Tvrdek M, Kozák J, Cerný M, Zach J (2007). Our first experience with primary lip repair in newborns with cleft lip and palate. Acta Chir Plast. 49/4: 83–87.
3. Borský J, Velemínská J, Jurovčík M, Kozák J, Hechtová D, Tvrdek M, et al. (2012). Successful early neonatal repair of cleft lip within first 8 days of life. Int J Pediatr Otorhinolaryngol. 76/11: 1616–1626.
4. Cao C, Xu X, Shi B, Zheng Q, Li J (2017). Is cleft severity correlated with intrinsic growth pattern? Observation from unoperated adult patients with submucous cleft palate. J Craniofac Surg. 28/6: 1451–1455.
5. Cohen M, Marschall MA, Schafer ME (1992). Immediate unrestricted feeding of infants following cleft lip and palate repair. J Craniofac Surg. 3/1: 30–32.
6. Hoffmannová E, Bejdová Š, Borský J, Dupej J, Cagáňová V, Velemínská J (2016). Palatal growth in complete unilateral cleft lip and palate patients following neonatal cheiloplasty: classic and geometric morphometric assessment. Int J Pediatr Otorhinolaryngol. 90: 71–76.
7. Hoffmannová E, Cagáňová V, Dupej J, Borský J., Bejdová, Š., Velemínská J (2018). Three-dimensional development of the upper dental arch in unilateral cleft lip and palate patients after early neonatal cheiloplasty. Int J Pediatr Otorhinolaryngol. 109: 1–6.
8. Honda Y, Suzuki A, Ohishi M, Tashiro H (1995). Longitudinal study on the changes of maxillary arch dimensions in Japanese children with cleft lip and/or palate: infancy to 4 years of age. Cleft Palate Craniofac J. 32/2: 149–155.
9. Huang CS, Wang WI, Liou EJ, Chen YR, Chen PK, Noordhoff MS (2002). Effects of cheiloplasty on maxillary dental arch development in infants with unilateral complete cleft lip and palate. Cleft Palate Craniofac J. 39: 513–516.
10. Hutton TJ, Buxton BF, Hammond P (2001). Dense surface point distribution models of the human face. In: Proceedings IEEE workshop on mathematical methods in biomedical image analysis (MMBIA 2001), Kauai, Hawaii, USA, 9–10 December 2001; 153–160.
11. Jabbari F, Hakelius MM, Thor AL, Reiser EA, Skoog VT, Nowinski DJ (2017). Skoog primary periosteoplasty versus secondary alveolar bone grafting in unilateral cleft lip and alveolus: Long-term effects on alveolar bone formation and maxillary growth. Plast Reconstr Surg. 139/1: 137–148.
12. Kramer GJ, Hoeksma JB, Prahl-Andersen B (1992). Early palatal changes in complete and incomplete cleft lip and/or palate. Acta Anat (Basel). 144/3: 202–212.
13. Kuderová J, Borský J, Černý M, Müllerová Z, Vohradník M, Hrivnáková J (1996). Care of patients with clefts at the Department of Plastic Surgery in Prague. Acta Chir Plast. 38/3: 99–103.
14. Peterka M, Peterková R, Tvrdek M, Kuderová J, Likovský Z (2000). Significant differences in the incidence of orofacial clefts in fifty-two Czech districts between 1983 and 1997. Acta Chir Plast. 42/4: 124–129.
15. Ross RB (1987). Treatment variables affecting facial growth in complete unilateral cleft lip and palate. Part 7: an overview of treatment and facial growth. Cleft Palate J. 24/1: 71–77.
16. Smahel Z, Müllerova Z, Nejedly A, Horak I (1998). Changes in craniofacial development due to modifications of the treatment of unilateral cleft lip and palate. Cleft Palate Craniofac J. 35/3: 240– 247.
17. Weatherley-White RC, Kuehn DP, Mirrett P, Gilman JI, Weatherley-White CC (1987). Early repair and breast-feeding for infants with cleft lip. Plastic Reconstr Surg. 79/6: 879–887.
18. Ye B, Ruan C, Hu J, Yang Y, Thomas J, Zhang G (2012). A comparative study on the measurements of palatal shelf area and gradient for adult patients with unoperated cleft palate. Cleft Palate Craniofac J. 49/5: 561–565.
19. Živicová V, Lacina L, Mateu R, Smetana K Jr., Kavková R, Drobná Krejčí E, et al. (2017). Analysis of dermal fibroblasts isolated from neonatal and child cleft lip and adult skin: Developmental implications on reconstructive surgery. Int J Mol Med. 40/5: 1323–1334.
