The Effects of Gingivoperiosteoplasty and Cleft Palate Repair on Facial Growth.

BACKGROUND

Gingivoperiosteoplasty (GPP) can avoid secondary alveolar bone graft in up to 60% of patients. The effects of GPP on maxillary growth are a concern. However, palatoplasty can also negatively impact facial growth. This study quantifies the isolated effects of GPP and cleft palate repair on maxillary growth at the age of mixed dentition.

METHODS

A single-institution, retrospective study of all patients undergoing primary reconstruction for unilateral cleft lip and alveolus (CLA) or cleft lip and palate (CLP) was performed. Study patients had lateral cephalograms at the age of mixed dentition. Patients were stratified into four groups: CLA with GPP (CLA + GPP), CLA without GPP (CLA - GPP), CLP with GPP (CLP + GPP), and CLP without GPP (CLP - GPP). Cephalometric measurements included the following: sella-nasion-point A (SNA), sella-nasion-point B (SNB), and A point-nasion-B point. Landmarks were compared between patient groups and to Eurocleft center D data.

RESULTS

One hundred ten patients met inclusion criteria: seven CLA - GPP, 16 CLA + GPP, 24 CLP - GPP, and 63 CLP + GPP patients. There were no significant differences in SNA, SNB, and A point-nasion-B point between CLA + GPP and CLA - GPP, or between CLP + GPP and CLP - GPP groups. In patients who did not receive GPP, SNA was significantly lower in patients with a cleft palate compared with patients with an intact palate ( P < 0.05). There were no significant differences in SNA or SNB of CLP - GPP or CLP + GPP groups when compared with Eurocleft data.

CONCLUSION

When controlling for the effects of cleft palate repair, GPP does not appear to negatively affect midface growth at the age of mixed dentition.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.