Original Investigation |

Effect of Lip Closure on Early Maxillary Growth in Patients With Cleft Lip and Palate

Pascal Rousseau, MD, PhD1,2; Marc Metzger, MD, DDS, PhD1; Sibylle Frucht, DDS1,3; Wipke Schupp, MD, DDS1; Mareike Hempel, DDS1; Jörg-Elard Otten, MD, DDS, PhD1
[+] Author Affiliations
1Department of Oral, Maxillofacial, and Facial Plastic Surgery, University of Freiburg, Freiburg, Germany
2Department of Plastic, Aesthetic, and Reconstructive Surgery, Centre Hospitalier Universitaire, Angers, France
3Department of Orthodontics, University of Freiburg, Freiburg, Germany
JAMA Facial Plast Surg. 2013;15(5):369-373. doi:10.1001/jamafacial.2013.335.
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Importance  Debate continues about the cause of midfacial growth disturbance in patients with facial clefts.

Objective  To evaluate the functional effect of surgical closure of the lip before palatal closure according to the technique by Delaire on early maxillary growth in patients with complete unilateral cleft lip and palate.

Design, Setting, and Participants  Twenty-two patients with unilateral cleft lip and palate were studied using plaster casts obtained at the time of cheilorhinoplasty and 6 months later before palatal closure. The interrupted lateral muscles were anatomically repositioned using the surgical technique by Delaire. No patients had received preoperative orthodontic treatment or a passive palatal plate. Cast analyses were performed using a digital caliper.

Main Outcomes and Measures  Landmark positioning was performed 3 times by 2 different examiners to define intraobserver and interobserver differences. The final maxilla dimensions were recorded as the distances between the mean landmark positions. Using the t test, dimensions obtained before palatal closure were compared with dimensions obtained before lip closure.

Results  The method allowed good reproducibility. Functional closure of the lip significantly narrowed the transverse anterior cleft areas by −2.36 mm (P < .05). Sagittal variables were increased by 1.68 mm on the nonaffected side and by 1.48 mm on the affected side (P < .05 for both).

Conclusions and Relevance  Functional closure according to the technique by Delaire narrows the transverse dimensions of the maxilla, while simultaneously preserving initial sagittal growth.

Level of Evidence  4.

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Figure 1.
Eleven Landmarks Defined on the Plaster Casts to Measure Bilateral Frontal, Sagittal, and Vertical Maxillary Dimensions

A, Landmarks used for maxillary measurements. B, Distances used for maxillary measurements. I indicates incisory point; C1-C1′, anterior canine point; C2-C2′, posterior canine point; G-G′, point where the lateral sulcus intersects the gingival groove; S-S′, anterior points of the cleft segment of the alveolar rind; and B-B′, base point of the foveolae palatinae.

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Figure 2.
Summary of Results

A, Maxillary measurements after lip closure. B, Maxillary growth (synthetic results) in millimeters. Black indicates decreased values; red, increased values. Three values (B-B′, I-S, and I-C2′) demonstrated no significant change during the period between lip closure and palatal treatment and are not shown. Functional closure of the lip according to the technique by Delaire leads to narrowing of the lateral dimensions of the maxilla, while preserving early maxillary sagittal growth on the noncleft side (I-C1, I-C2, and C2-B) and on the cleft side (C2′-B′).

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