Facial development in unilateral cleft lip and palate prior to the eruption of permanent incisors after primary bone grafting and periosteal flap surgery.

Roentgencephalometric studies were carried out at the age of five years in 27 boys with unilateral cleft lip and palate after primary bone grafting, as well as in 25 boys with the same type of cleft after primary periosteoplasty and in 27 normal boys who served as a group of controls. Both series with clefts differed from the group of controls by a reduced upper face height, maxillary dentoalveolar retroinclination, posterior position of the maxilla and by the shortening of mandibular body and ramus. There was a slight reduction of maxillary depth only in the series with bone grafts. The other skeletal deviations were secondary. The soft profile showed in both series with clefts a reduction of the upper lip height and of the nasal prominence. In patients with bone grafts was recorded in addition a reduced prominence of the upper lip. A comparison of both series with clefts disclosed that primary bone grafting reduced the vertical growth of the upper face and increased the dentoalveolar retroinclination of the maxilla resulting in a larger impairment of overjet and in a more marked retrocheilia. A better prominence of the nose in the series with periosteal flap surgery was produced by the primary reposition of the nasal septum, which was not performed during osteoplasty.