ABSTRACT
Palatal scarring is assumed to be a primary cause of facial growth derangement in cleft lip and palate. Evidence supporting this hypothesis is confounded by the clinical involvement of various surgeons, and therefore definitive conclusions are not possible. In this study, we investigated the dental arch relationship in two groups, Exposed (47 children; 11.2 yrs) and Unexposed (61 children; 11.2 yrs), with a unilateral cleft lip and palate operated on by the same surgeon. The technique of hard palate repair differed between the two groups. In the Exposed group, palatal bone of the non-cleft side only was left denuded, inducing scar formation. In the Unexposed group, a vomerplasty with tight closure of the soft tissues was applied. Three raters graded the dental arch relationship and palatal morphology using the EUROCRAN Index. The dental arch relationship in the Exposed group was less favorable than in the Unexposed group (p = 0.009). Palatal morphology in both groups was comparable (p = 0.323). This study demonstrates that reduction of denuded bony areas on the palate after palatal repair with a vomer flap had a favorable effect on the dental arch relationship. For palatal morphology, no effect of the type of palatal repair was found.
Subject(s)
Cleft Lip/surgery , Cleft Palate/surgery , Malocclusion/prevention & control , Oral Surgical Procedures/methods , Plastic Surgery Procedures/methods , Cicatrix/complications , Cicatrix/prevention & control , Dental Arch/growth & development , Female , Humans , Infant , Male , Malocclusion/etiology , Maxillofacial Development , Palate, Hard/surgery , Regression Analysis , Retrospective Studies , Surgical Flaps , Vomer/surgeryABSTRACT
During the period between 1993 and 1998 thirty-one children with symptoms of Pierre-Robin sequence were treated. Since gastroesophageal reflux (GER) is known to occur in patients with Pierre - Robin sequence, each child before surgery was checked for GER. In 28 cases GER was confirmed. We obtained rapid clinical improvement and possibility of early discharge from hospital after surgical treatment (palatoplasty, SRFM - subperiosteal release of the floor of the mouth, repair of the palato-pharyngeal ring). Follow up investigations few months after surgery showed no clinical symptoms of GER. The authors find evidence of " palatal mechanism" of GER in Pierre-Robin sequence and in their opinion early closure of the impaired palto-pharyngeal ring and elimination of mechanism causing posterior rotation of the tonque can reduce indications for such surgical procedures as glossopexy, gastrostomy, tracheostomy and Nissen fundoplication.
