Growth of the Vomero-Premaxillary Suture in Children with Bilateral Cleft Lip and Palate

Abstract

The significance of the vomero-premaxillary suture (VPS) in mid-facial development in patients with complete bilateral cleft lip and palate (C-BCLP) was evaluated. Histological analysis of the VPS in eight specimens, ranging in age from full term to 22 months, revealed evidence of growth at both sutural borders. Various theories to explain the consistent presence of secondary cartilage, localized mainly to the posterior end of the suture, were assessed. It was considered most likely that the formation of cartilage was promoted by mechanical stresses, set up during a period of rapid growth. Roentgencephalometric data from seven C-BCLP patients (age range: 2–7 months) demonstrated the existence of a true, rather than a relative, premaxillary protrusion. Five patients had metallic implants inserted on either side of the VPS at the time of initial surgery and were followed up roentgencephalometrically to ages ranging from 5 to 36 months. Although continuous growth was recorded in the VPS, there was a post-surgical decrease in the premaxillary protrusion. On the basis of both the histology and roentgencephalometry it was concluded that traumatic surgery involving the VPS would be likely to contribute to the impaired mid-facial growth sometimes seen in operated C-BCLP patients.