Vertical development of the cleft segments in infants with bilateral cleft lip and palate: effect of dentofacial orthopedic and surgical treatment on maxillary morphology from birth to the age of 11 months.

OBJECTIVE: The aim of this investigation was to use 3D (threedimensional) analysis of maxillary casts to document and graphically demonstrate the clinically-visible vertical deviation of the premaxilla and lateral segments from a defined reference plane, and to describe the effect of presurgical dentofacial orthopedic treatment and cleft lip operation.

MATERIAL AND METHODS: The maxillary morphology of 17 infants with bilateral cleft lip and palate (investigation group) was examined by means of 3D cast measurement with a reflex microscope from the time of birth to the age of 11 months. All the patients were treated at the Dental Center of the University of Leipzig according to the same treatment approach [15], which in the first year of life entails the insertion of a modified palatal plate according to Hotz [17, 18], one-stage surgical repair of the cleft lip (at the age of 4-6 months on average), and closure of the hard and soft palates 6 months later. We selected the casts of 14 patients to use as the control group; they had been treated according to a different approach at, what at that time was, the Wolfgang Rosenthal Clinic for Plastic and Reconstructive Maxillofacial Surgery in Thallwitz.

RESULTS: We observed vertical deviations of the cleft segments during the investigation period. Following surgical repair of the cleft lip, there was a caudal shift of the premaxilla in both groups that was cranially rotated before the operation. The investigation group also revealed a reduction in the vertical deviation of the lateral segments. We noted a harmonization in the position of the segments in the investigation group, however, this harmonization was not achieved in the control group.