Upper dental arch morphology of adult unoperated complete bilateral cleft lip and palate.

Literature has shown that, even with the conservative nontraumatic surgical techniques, early repairing surgeries induce changes in the upper dental arch morphologic characteristics in patients with cleft lip and palate. The evaluation of unoperated adult cleft patients enables us to exclude the influence of treatment, emphasizing the morphologic characteristics inherent to the presence of the cleft and its functional counterbalances, that is, the morphologic pattern imposed by cleft. In this study, the maxillary dental casts of 31 unoperated adult complete bilateral cleft lip and palate patients (20 men and 11 women) were compared to a noncleft sample matched for gender. Intercanine, inter-first premolar, inter-second premolar and inter-first molar arch widths measurements as well as arch length were measured from xerox copies taken of the models. The findings indicate the presence of premaxillary prognathism and a progressive increase in the constriction of the dental arches. This constriction of the maxillary segments, even in the absence of surgical intervention, is a result of the absence of an intact palate between the two maxillary processes. Although gender significantly influenced the size of the maxillary arches in the noncleft patients, similar differences were not observed in the cleft group. It seems that the presence of the cleft in itself has the greater influence on the morphologic characteristics of the maxillary arch than gender.

A methodology report of a randomized prospective clinical trial to assess velopharyngeal function for speech following palatal surgery.

Cleft lip and palate occurs in approximately 1 in every 750 live human births, making it one of the most common congenital malformations. Surgical closure of the palatal cleft does not always result in a velopharyngeal port capable of supporting normal speech. The University of Florida (UF), in collaboration with the University of São Paulo (USP), is engaging in a 5-year prospective, randomized controlled study to compare velopharyngeal function for speech outcomes between patients undergoing palatoplasty for complete unilateral cleft lip and palate performed using the von Langenbeck procedure with intravelar velarplasty and those receiving the Furlow double-reversing Z-plasty palatoplasty. The von Langenbeck procedure was selected as the time-tested standard against which the Furlow procedure could be judged. The Furlow procedure, a relatively new operation, has been reported to yield substantially higher rates of velopharyngeal competency for speech than have most other reported series and theoretically should result in less disturbance to midfacial growth. A total of 608 patients will be entered into one of two age categories. Inclusion of two age groups will allow a comparison of results between patients having surgery before 1 year of age (9-12 months) and patients undergoing surgery at approximately 1.5 years of age (15-18 months). Speech data will be collected and will be available for definitive analysis throughout the last 3 years of the study. Collection of preliminary growth data will require more than 5 years; growth analysis is anticipated to continue until all patients have reached maturity. The Hospital for Research and Rehabilitation of Patients with Cleft Lip and Palate at the University of São Paulo (USP-HPRLLP) in Bauru, Brazil, is uniquely situated for conducting this study. The well-equipped and modern facilities are staffed by well-trained specialists representing all disciplines in cleft-palate management. In addition, an already existing social services network throughout Brazil will ensure excellent follow-up of study cases. The clinical caseload at this institution currently exceeds 22,000, and more than 1200 new cases are added annually. This project represents a unique opportunity to obtain prospective data from a large number of subjects while controlling the variables that have traditionally plagued cleft-palate studies. This study is designed to determine which of the two proposed surgical procedures is superior in constructing a velum capable of affecting velopharyngeal competency for the development of normal speech.