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Stomatologija 2014; 16 (2): 53-60 46 KB

How various surgical protocols of the unilateral cleft lip and palate influence the facial growth and possible orthodontic problems? Which is the best timing of lip, palate and alveolus repair? Literature review

Giampietro Farronato, Laima Kairyte, Lucia Giannini, Guido Galbiati, Cinzia Maspero

Summary

Objectives. Cleft lip palate is congenital growth disease with unknown etiology, probably linked to both genetically and external causes. The aim of this work consists in presenting the effects of these diseases on cranio facial growth and the surgical protocols described in literature.

Materials and methods. The literature review articles conducted by Medline ranged from 1998 to 2011 have been selected. The key words of the research were “cleft lip palate”, “cleft lip palate facial growth”, “cleft lip palate surgery”. The inclusion criteria were articles that analyzed surgical protocols and the growth of unilateral lip and palate clefts, the timing repair of lip, palate and alveolus. We excluded case reports, studies without control group in the sample and the other types of publication as thesis or conference presentation. 60 articles had the selection criteria of the research.

Results. The cleft lip and palate is one of the most common birth defects that needs long rehabilitation between birth and adulthood. Several authors have presented surgical protocols and timing. The effects of these diseases on cranio facial growth and the importance of the early intervention have been described.

Conclusions. The review describes the main surgical protocols and treatment strategies of the unilateral lip and palate clefts. The review discusses how surgery effects the midfacial skeletal growth. Studies agree that the palate repair is the main cause of the maxilla growth disturbances. About the timing of palate repair in the unilateral clefts it can be concluded that most studies found no difference between one or two stages palate repair techniques for the midfacial growth. Also from the research, studies agree that delayed hard palate repair has more positive effects on maxillary growth than that of early hard palate repair. Nevertheless good results, delayed hard palate repair technique is abandoned by many hospital centres because of worse speech outcome. The best technique of palate repair is difficult to conclude, because the research results are part of a big controversy between the centers. From the studies about the alveolar repair it can be concluded that the primary bone grafting had more negative results on the skeletal growth. Gingivoperiosteoplasty and the secondary bone grafting had more positive results for intracranial relationship. The studies agree that the best timing of lip repair is during third-sixth month of life and that lip repair could have negative influence on the maxillary growth.

Key words: cleft lip palate facial growth, cleft lip palate surgery.

Received: 15 04 2013

Accepted for publishing: 20 06 2014

^*Maxillo-Facial and Odontostomatology Unit, Fondazione IRCCS Cà Granda – Ospedale Maggiore Policlinico, University of Milan, Milan, Italy

Giampietro Farronato^* – M.D., D.D.S.

Laima Kairyte^* – D.D.S.

Lucia Giannini^* – D.D.S.

Guido Galbiati^* – D.D.S.

Cinzia Maspero^* – M.D., D.D.S.

Address correspondence to Prof. Giampietro Farronato, Via Commenda 10, 20122 Milan Italy. E-mail address: giampietro.farronato@unimi.it



	Baltic Dental and Maxillofacial Journal

June, 2014, Vol. 16, No. 2 CONTENTS REVIEWS Odontogenic maxillary sinusitis: A review Regimantas Simuntis, Ričardas Kubilius, Saulius Vaitkus 39-43 Reducing dental plaque formation and caries development. A review of current methods and implications for novel pharmaceuticals Povilas Kalesinskas, Tomas Kačergius, Arvydas Ambrozaitis, Vytautė Pečiulienė, Dan Ericson 44-52 How various surgical protocols of the unilateral cleft lip and palate influence the facial growth and possible orthodontic problems? Which is the best timing of lip, palate and alveolus repair? Literature review Giampietro Farronato, Laima Kairyte, Lucia Giannini, Guido Galbiati, Cinzia Maspero 53-60 SCIENTIFIC ARTICLES Assessment of the lateral pterygoıd plate fractures durıng Le Fort I osteotomıes regardıng the angulatıon of the osteotome Aydin Gulses, Hasan Ayberk Altug, Cenk Kılıc, Metin Sencımen 61-64 Self-reported oral health behavior and attitudes of dental and technology students in Lithuania Ingrida M. Pacauskiene, Dalia Smailiene, Jolanta Siudikienė, Julija Savanevskyte, Irena Nedzelskiene 65-71 CASE REPORT Non surgical treatment of Crouzon Syndrome Cinzia Maspero, Lucia Giannini, Guido Galbiati, Laima Kairyte, Giampietro Farronato 72-80 © 2014 Stomatologija		Stomatologija 2014; 16 (2): 53-60 46 KB How various surgical protocols of the unilateral cleft lip and palate influence the facial growth and possible orthodontic problems? Which is the best timing of lip, palate and alveolus repair? Literature review Giampietro Farronato, Laima Kairyte, Lucia Giannini, Guido Galbiati, Cinzia Maspero Summary Objectives. Cleft lip palate is congenital growth disease with unknown etiology, probably linked to both genetically and external causes. The aim of this work consists in presenting the effects of these diseases on cranio facial growth and the surgical protocols described in literature. Materials and methods. The literature review articles conducted by Medline ranged from 1998 to 2011 have been selected. The key words of the research were “cleft lip palate”, “cleft lip palate facial growth”, “cleft lip palate surgery”. The inclusion criteria were articles that analyzed surgical protocols and the growth of unilateral lip and palate clefts, the timing repair of lip, palate and alveolus. We excluded case reports, studies without control group in the sample and the other types of publication as thesis or conference presentation. 60 articles had the selection criteria of the research. Results. The cleft lip and palate is one of the most common birth defects that needs long rehabilitation between birth and adulthood. Several authors have presented surgical protocols and timing. The effects of these diseases on cranio facial growth and the importance of the early intervention have been described. Conclusions. The review describes the main surgical protocols and treatment strategies of the unilateral lip and palate clefts. The review discusses how surgery effects the midfacial skeletal growth. Studies agree that the palate repair is the main cause of the maxilla growth disturbances. About the timing of palate repair in the unilateral clefts it can be concluded that most studies found no difference between one or two stages palate repair techniques for the midfacial growth. Also from the research, studies agree that delayed hard palate repair has more positive effects on maxillary growth than that of early hard palate repair. Nevertheless good results, delayed hard palate repair technique is abandoned by many hospital centres because of worse speech outcome. The best technique of palate repair is difficult to conclude, because the research results are part of a big controversy between the centers. From the studies about the alveolar repair it can be concluded that the primary bone grafting had more negative results on the skeletal growth. Gingivoperiosteoplasty and the secondary bone grafting had more positive results for intracranial relationship. The studies agree that the best timing of lip repair is during third-sixth month of life and that lip repair could have negative influence on the maxillary growth. Key words: cleft lip palate facial growth, cleft lip palate surgery. Received: 15 04 2013 Accepted for publishing: 20 06 2014 ^Maxillo-Facial and Odontostomatology Unit, Fondazione IRCCS Cà Granda – Ospedale Maggiore Policlinico, University of Milan, Milan, Italy Giampietro Farronato^ – M.D., D.D.S. Laima Kairyte^* – D.D.S. Lucia Giannini^* – D.D.S. Guido Galbiati^* – D.D.S. Cinzia Maspero^* – M.D., D.D.S. Address correspondence to Prof. Giampietro Farronato, Via Commenda 10, 20122 Milan Italy. E-mail address: giampietro.farronato@unimi.it