The Influence of Primary Periosteoplasty on Maxillary Growth and Deciduous Occlusion in Cases of Complete Unilateral Cleft Lip and Palate: A Longitudinal Study from Infancy to the Age of 5

Abstract

The influence of infant periosteoplasty upon the growth of the maxilla, its form and size, and the prevalence of malocclusion in the deciduous dentition was investigated. The material consisted of 66 patients with total unilateral clefts of the primary and secondary palate. Thirty-six had periosteoplasty performed in conjunction with cleft-lip and/or palate repair. Thirty patients were operated upon without periosteoplasty and served as controls. Repair of the lip had a notable effect upon the width of the alveolar cleft and palatal cleft, both in the periosteoplasty cases and in the controls, with no certain difference between the groups. Following lip repair, the anterior width of the alveolar arch was slightly reduced. After palatal repair a further reduction was noted in the deciduous dentition, both in the cases treated with periosteoplasty and in the controls, while the posterior width of the palate across the tuberosities increased during growth. In the deciduous dentition, no differences were found in intercanine and intermolar dimensions between the periosteoplasty cases and the controls. Thus, the new bone formed in the cleft area after periosteoplasty does not seem to withstand the contracting forces introduced by palate surgery. An increased length of the buccal alveolar arch on the cleft side, compared with that on the non-cleft side, was found at both the lip repair and the palate repair in the periosteoplasty cases, as well as in the controls. In the deciduous dentition, this difference was negligible. In the deciduous dentition an anterior position of the lateral maxillary segment proved more common in the periosteoplasty cases than in the controls. On the non-cleft side, there was an increased frequency of mesial occlusion and a corresponding decrease of neutral and distal occlusion in the periosteoplasty cases. No increased frequency of anterior crossbite was found even after repeated periosteoplasty, nor was the maxillary dental-arch length unfavourably influenced. Descriptive analysis of occlusion revealed an increase of buccal crossbite in the periosteoplasty cases of a select group of the widest clefts, treated by repeated periosteoplasty. These cases also had the highest total occlusal score according to the numerical classification, while the total occlusal score after one periosteoplasty in patients with less wider clefts was smaller than in the controls. In all patients who had undergone periosteoplasty new bone formed within the alveolar cleft. A good amount of new bone developed in about half the number of cases. Bone formation increased after repeated periosteoplasty and new bone bridging the cleft was then a constant finding. In conclusion the present study demonstrates that infant periosteoplasty, involving transfer of local periosteum across the alveolar cleft, is effective in restoring the bony framework and that the procedure does not retard or impair growth of the maxilla during a follow-up period of 5 years.