Maxillary Segmental Stability in Cleft Lip and Palate Subjects

Abstract

The value of early orthopedic treatment of cleft lip and palate, as McNeil originally described in 1954 (I), has been doubted by several authors. To ascertain the advantage, if any, of this kind of treatment, all our patients with cleft lip and palate who have been treated since 1958 were examined. For this study, only those patients treated by the same surgeon and the same orthodontist were examined in order to avoid dif— ferences in results due to variations in operative procedures by different surgeons. The investigation should tell us about the postoperative stability of the cleft maxillae after presurgical orthopedic treatment, in comparison to when it is not done. We were specifically interested in the period between surgical closure of the cleft hard and soft palate at 21/2 years of age and the eruption of the permanent incisors in the maxilla at 6 to 8 years. The eruption of the permanent incisors was chosen as the terminal point for this investigation, because most incisors which erupt near the cleft are in a rotated position and need orthodontic treatment. What do we mean by stability? We chose the following criteria to judge it in a cleft palate case: a) the two or three segments must remain in correct alignment during the growth period in which we are interested , and b) the maxilla must retain its normal occlusion with the mandible. Any deviation from these two criteria was considered a sign of instability. Material F orty-eight cases were used in the present study and these were divided into the following 2 groups. Group A was comprised of 18 patients who had had no early orthopedic treatment. 15 had complete unilateral and 3 had complete bilateral clefts. In Group B were 30 patients who had been treated by early orthopedic means. 17 had unilateral and 13 had bilateral clefts. The authors are affiliated with the