Aesthetic and functional outcome of surgical and orthodontic correction of bilateral clefts of lip, palate, and alveolus.

OBJECTIVE

To assess the aesthetic and functional long-term results of surgical and orthodontic treatment of patients with bilateral cleft lip, palate, and alveolus.

DESIGN

Long-term follow-up study.

SETTING

Teaching hospital in Austria.

PATIENTS

Twenty adult patients who had been operated on as children for bilateral cleft lip, palate, and alveolus.

INTERVENTIONS

Lateral cephalometric and model analysis. The sum of all mesiodistal tooth diameters in the maxilla and mandible were compared with standard Bolton tracings.

MAIN OUTCOME MEASURES

Aesthetic and functional results. RESULTS (MODEL ANALYSIS): The upper arch was too wide in 12 patients and the mandibular arch was too wide in 4 patients. In 11 patients, the lateral teeth were crowded, and all had a persistent transverse space deficit and a reduction in sagittal measurements. Fifteen patients had alveolar midline displacement of the maxilla as well as of the mandible. RESULTS (LATERAL CEPHALOMETRIC MEASUREMENTS): The lateral cephalograms showed a mean sella-nasion-A point angle of 77 degrees and a maxillary baseline-nasion-sella line angle of 9 degrees, indicating a tendency toward maxillary retrognathia. An anterior facial height index of 42% (compared with the standard 58%) indicated a slight reduction in midface height with consequent increase in the height of the lower face.

CONCLUSION

There is specific growth impairment of the midface in adults who were treated as children for bilateral clefts of lip, palate, and alveolus. An optimal result can be achieved only by additional orthognathic surgery (Le Fort II osteotomy).