Effects of lip adhesion and presurgical orthopedics on facial growth: an evaluation of four treatment protocols.

Differences in craniofacial morphology in uni and bilateral cleft lip and palate were studied by roentgenocephalometry: 35 American children, treated with a lip adhesion procedure, and 26 Dutch children treated with a preoperative orthopedic procedure, both followed by a lip and/or palatal repair, were compared. A multivariate statistical approach was used to study the effects of the surgical procedures and of the age of the child when operated upon. The variables affected by the type of operation were: the relative length of the maxilla (PNS-ANS); the SNA angle; and the relative length of the mandible (Go-Po). The length of the maxilla was on average longer for those treated with preoperative orthopedics and the maxilla was largest for children whose hard palate had yet to be closed. This was also the case for the SNA angle except for children treated with the combined lip-soft palate closure procedure. The mandible followed pattern displayed by the maxillary length; it was larger for those treated with preoperative orthopedics. Significant effects of the timing of the surgery on the variables studied were also found. Postponement of the definitive lip closure resulted in a reduction of the maxillary length, whereas delay of soft palatal closure resulted in an increase of the maxillary length.