Influence of Premaxillary Position on Oral Trauma in Early Childhood: A 10-Year Study of Cleft Lip and Palate Patients.

BACKGROUND

Cleft lip and palate (CLP) is a common craniofacial anomaly that predisposes affected children to orofacial trauma due to altered anatomy. Among the subtypes of CLP, patients with bilateral cleft lip and palate (BCLP) present with a prominent protruding premaxilla, which significantly increases their vulnerability to trauma during early development. Despite this, data on trauma patterns and anatomical risk factors in infants and toddlers with BCLP remain limited.

OBJECTIVES

To investigate the prevalence, mechanisms and severity of oral and facial trauma in BCLP patients aged 0-3 years and to assess the association between Premaxillary Position and Trauma (PPT) Risk using a structured scoring system.

METHODS

A retrospective analysis of 13,975 cleft cases over a 10-year period (2015-2025) was performed at a tertiary cleft center. A total of 4388 patients who underwent primary cheiloplasty, 513 BCLP patients aged 0-3 years were included. Trauma incidence, injury characteristics, and premaxillary position were assessed using the PPT Risk score, which includes transverse, anteroposterior, and vertical position assessments.

RESULTS

Thirty-five BCLP patients sustained trauma, with age-specific differences in injury mechanisms: falls from heights and vehicular incidents were common in preoperative infants (≤ 6 months), whereas ground-level falls predominated in postoperative toddlers (6-36 months). Soft tissue injuries were most common (45.71%), followed by premaxillary mobility disorders (17.14%) and dental trauma (17.14%). Patients with a highly protruding premaxilla (Type 1b, 2b, and 3a) had the highest trauma incidence (54.29%), indicating a strong correlation between premaxillary position and injury risk.

CONCLUSION

BCLP patients, especially those with anteriorly and vertically prominent premaxilla, have a significantly increased risk of trauma in early childhood. The PPT score is an effective tool for trauma risk stratification and supports the implementation of early interventions such as presurgical orthopedics and targeted caregiver education.