Unilateral Complete Cleft Lip and Palate Repair Using Lip Adhesion and Passive Alveolar Molding Appliance: Effect on the Maxillary Alveolar Arch

ABSTRACT

To manage a unilateral complete cleft lip and palate, lip adhesion along with the positioning of a passive alveolar molding appliance was performed in infants at 4 to 6 weeks of age. The lip adhesion creats a force acting on the cleft alveolus. Thereafter, the greater segment of the alveolus is guided by the appliance, while the lesser segment of the alveolus is prevented from collapsing. Definite cheiloplasty was then performed at 4 to 5 months of age and palatoplasty at 12 months of age. Twenty-five patients with a unilateral complete cleft lip and palate were treated using this protocol from 1994 to 2002. Fifteen were male and ten were female. The mean follow-up period was one to nine years. Dental cast measurements were performed at lip adhesion, definite cheiloplasty and palatoplasty in 18 patients, 3 to 9 years in 19 patients. The alveolar gap, length of maxillary alveolar cleft, width of maxillary alveolar cleft and palatal gap were 10.1 +/-4.2mm, 6.1+/-0.9mm, 10.2+/-4.8mm, 13.4+/-2.9mm at lip adhesion, 3.1+/-1.4mm, 2.6+/-0.8mm, 2.7+/-1.6mm, 9.6+/-1.5mm at definite cheiloplasty, and 0.2+/-0.1mm, 1.5+/-0.7mm, 0.2+/-0.1mm, 8.3+/-1.1mm at palatoplasty respectively. Measurements at palatoplasty were decreased with statistical significance(p<0.05). Twenty- three patients developed good symmetrically aligned alveolar segments plus a symmetric platform for the nose. However, two patients developed poor maxillary orthopedics because of the displacement of the appliance by the patient. On the following maxillary dental cast from 8 to 9 years, intercanine width and canine arch length were within the normal value. However, intermolar width and molar arch length was decreased slightly compared to the normal with a statistical significance (p<0.005). In conclusion, lip adhesion and passive alveolar molding appliance achieve a normal position and stabilizing the arch, a symmetrical platform. However, longer follow- up is necessary until 15 years old for permanent dental arch establishment.