Facial Growth in Patients With Bilateral Cleft Lip and Palate After two-Stage Palatoplasty Using Vomer Flap

Abstract

Objective

This study aimed to assess the impact of two-stage palatoplasty incorporating a vomer flap on facial growth of individuals with bilateral cleft lip and palate (BCLP).

Setting

Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil.

Design

A cross-sectional study involving patients who underwent labial adhesion and anterior palatoplasty with a vomer flap at 3 and 5 months, followed by posterior palatoplasty at 12 months. Individuals without prior orthodontic treatment or secondary alveolar bone grafting were included. Cephalometric radiographs were obtained during mixed or early permanent dentition. A control group of untreated class I individuals without clefts was evaluated.

Participants

The sample comprised 49 individuals with BCLP (17 females, 32 males; mean age 8.91 years) and 44 control subjects (17 females, 27 males; mean age 8.91 years).

Main Outcome Measure

Cephalometric analysis was conducted using Dolphin Imaging software (version 11.95). Intergroup comparisons were performed using independent t-tests and Mann-Whitney U tests (P < .05).

Results

No significant difference between groups was found in maxillary sagittal position. However, BCLP group showed a significantly smaller SNB angle (mean difference −2.1°, P < .003) and a more convex skeletal profile compared to the noncleft group. Additionally, BCLP group exhibited severe lingual inclination of the maxillary incisors, (MD = –31.6°, P < .001) and a high prevalence of anterior crossbite.

Conclusion

At the time of observation, the maxillary sagittal position appeared comparable between groups. However, mandibular retrusion contributed to a more convex profile. The severe retroinclination of maxillary incisors determined a negative overjet. Longitudinal follow up are needed to confirm long-term maxillofacial growth outcomes.