Adolescent facial morphology of early bone-grafted cleft lip and palate patients.

A final evaluation of the effect of early bone grafting (EBG) on facial growth was carried out. The sample included 19 bilateral and 42 unilateral cleft lip and palate patients with an age range of 15-20 years, which meant on average 16 years after the EBG procedure. Roentgencephalometric data indicated maxillary retrognathia in both cleft categories and also deficient vertical descent of the maxilla, especially in the anterior part. In about 40% of the bilateral and 50% of the unilateral cleft patients, the mid-facial growth attenuation had reached such magnitude that surgical advancement of the maxilla was necessary. Analysis of plaster casts revealed that in every second cleft area the EBG operation had made it possible to achieve continuity in the dental arch without the need for prosthodontic replacement of teeth. Fusion of the suture between the (pre)maxilla and vomer was suggested as the reason for the typical mid-facial morphology seen in our patients with the most pronounced growth impairment.