Can Occlusal Evaluation Determinate Future Maxillofacial Morphology of Children with Unilateral Cleft Lip and Palate?

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Two studies were carried out ;(Study A) Correlation analyses between the occlusal relationship evaluated by the Goslon Yardstick and the maxillofacial growth measured from longitudinal cephalographs taken on 85 subjects with unilateral cleft lip and palate at the ages of five, ten, and over fifteen.(Study B) Comparison of maxillofacial growth patterns from 3-4 months old to fifteen years or older taken on longitudinal cephalographs of 38 male and 46 female CLP subjects among three cleft types ; unilateral cleft lip and alveolus(CLA), unilateral cleft lip and palate(CLP), and isolated cleft palate(CP). The followings were concluded from these two studies(1) Occlusal evaluation by the Five-year-old index or the Goslon Yardstick is a simple measure to represent maxilla-mandibular relationship, but those measures evaluate the outcome of maxillofacial growth until the time.(2) The occlusal evaluation by the Goslon Yardstick at ten years was similar with the one by the Five-year-old index at … More five years, furthermore orthodontic treatment has a tendency to make the outcome of occlusal evaluation better.(3) The outcome of occlusal evaluation has a significant relation with the amount and direction of mandibular growth rather than maxillary growth affected by labioplasty and/or palatoplasty in the subjects with unilateral cleft lip and palate.(4) Occlusal outcome evaluated by the Goslon Yardstick at the age of ten had no significant relation with future maxillofacial growth after then until adulthood. This suggests the maxillofacial growth in puberty may be great and determined the matured facial profile in adult. In this study, there were some CLP subjects who had been classified in good groups by the five-year-old index and the Goslon Yardstick, but underwent Orthognathic surgery in adulthood.(5) From the Study B comparing the longitudinal maxillofacial growth among the subjects with CLA, CLP, and CP, both labial and palatal plastic surgeries affected maxillofacial growth, but not mandibular growth. As our surgical procedure for palatal repair was the same one, the modified V-Y push back method, the effects of surgical procedures on maxillofacial growth will be evaluated and compared by the inter-centers study in future.(6) This study suggests that final maxillofacial morphology in adulthood will be determined by the genetic growth potential of the growing CLP children, especially in puberty. We need to evaluate the effects of more factors ; ones by plastic surgeries, genetic background, in order to predict the matured maxillofacial growth of the subjects with cleft lip and/or palate. Less