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Influence of lip closure on alveolar cleft width in patients with cleft lip and palate

DOI: 10.1186/1746-160x-7-3

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Abstract:

A total of 44 clefts were investigated using plaster casts, 30 unilateral and 7 bilateral clefts. All infants received a passive molding plate a few days after birth. The age at the time of closure of the lip was 2.1 month in average (range 1-6 months). Plaster casts were obtained at the following stages: shortly after birth, prior to lip closure, prior to soft palate closure. We determined the width of the alveolar cleft before lip closure and prior to soft palate closure measuring the alveolar cleft width from the most lateral point of the premaxilla/anterior segment to the most medial point of the smaller segment.After lip closure 15 clefts presented with a width of 0 mm, meaning that the mucosa of the segments was almost touching one another. 19 clefts showed a width of up to 2 mm and 10 clefts were still over 2 mm wide. This means a reduction of 0% in 5 clefts, of 1-50% in 6 clefts, of 51-99% in 19 clefts, and of 100% in 14 clefts.Early lip closure reduces alveolar cleft width. In most cases our aim of a remaining cleft width of 2 mm or less can be achieved. These are promising conditions for primary alveolar bone grafting to restore the dental bony arch.The treatment of children with a cleft lip and palate remains a challenge. Beginning at birth, it is necessary to balance several aspects of treatment such as growth, esthetics, function, and psychosocial development. Especially in children with a complete bilateral cleft lip and palate, many problems remain unsolved. Apart from intrinsic tissue deficiency and anatomic aberrations, there is difficulty in restoring the orbicularis oris muscle, in creating a philtrum, and in lengthening the columella. Furthermore, benefit of early orthopedic treatment is still questioned. Unrestricted premaxillary growth also gives rise to many problems. Surgeons have not reached consensus regarding best type and timing of lip- and palatal closure. Similarly, orthodontists have not reached agreement on early management of the alv

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