Oral and Craniofacial Characteristics of Untreated Adult Unilateral Cleft Lip and Palate Individuals

Introduction

Cleft lip and palate anomaly is one of the most frequently encountered congenital malformations caused due to morphologic changes, altered growth factors, and absolute tissue deficiency in the hard palate and abnormal tissues in the Maxillo-palatal region.¹

The defects usually associated with cleft lip and palate patients are those of growth in all three planes i.e. vertical, sagittal and transverse plane. The most striking feature in a cleft patient is the sagittal deficiency of the mid face leading to a concave facial profile. The mid facial deficiency is progressive and can be observed in early ages². The major morphologic characteristic in complete cleft lip and palate individuals is the result of altered response of skeletal elements to muscular deformation tendencies. Studies comparing the craniofacial features among cleft individuals have demonstrated significant differences in various parameters when compared with that of the non cleft individuals.^{3, 4, 5}

The Comprehensive management of Cleft lip and palate cases requires a team effort, consisting of various specialists. The multitudes of problems associated with the unfortunate individuals include Growth defects, Dental arch abnormalities^{6, 7}, and morphological defects^{8, 9} and also the esthetic and psychological trauma that the individual undergoes. Orthodontic treatment involves alveolar molding, arch expansions, growth modifications and arch alignments at different stages of management. The appropriate treatment regimen has to be selected based on the individual cases keeping in mind the patient's age and the growth status.¹⁰

Aims and objectives

The study was carried out to evaluate the facial morphology of untreated adult cleft lip and palate individuals and to compare them with that of non cleft individuals. The data obtained from the facial morphology of untreated adult cleft lip and palate individuals can be used as an aid in diagnosis and treatment planning and also as a standard guide for surgical and / or orthodontic intervention for cleft individuals.

Materials and Methods

32 Untreated Adult Unilateral Cleft lip and palate (UCLP) individuals and 32 Non Cleft individuals matched by age and gender were selected for the study as per the following inclusion criteria.

Group I: Control Group (15–28 yrs); 16 males and 16 females

• Adult Subjects with pleasing profile, Class I skeletal relationship, with near normal Occlusion

• No prior Ortho. / Surgical treatments

Group II: Untreated adult Cleft (15–28 yrs); 13 males and 19 females

• Unilateral Cleft lip and palate individuals with No history of prior treatments what so ever for the defect

Upper and lower study casts were prepared after obtaining the informed consent. Lateral & Frontal cephalograms were made under the standard conditions using PlanmecaProline 2002 machine (Planmeca, Finland) and were traced on to an acetate paper using 0.5mm pencil and were analyzed for the various craniofacial characteristics. A total of 7 parameters in lateral cephalogram [Fig.l] and 11 parameters in frontal cephalogram [Fig.2] were measured and analyzed. [Table l]

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Fig.1

Lateral Cephalometric measurements

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Fig.2

Frontal Cephalometric measurements

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The Data obtained were subjected to ANOVA test to determine the statistical significance between the groups.

Result

Discussion

Cleft lip and palate anomaly is one of the most frequently encountered congenital malformations. The defect usually associated with cleft lip and palate patients are those of growth in all three planes i.e. Vertical, Sagittal and Transverse planes. These patients are generally characterized as possessing abnormalities of the dental arch form, malocclusion, facial deformity and masticatory function.¹ In terms of gonial angle width, the results obtained in the present study are in contradiction with the study done by Dixon¹¹ in 1966, Ishiguro¹² et al in 1976, Ross and Johnston¹³in 1967. Dahl⁸, in a study reported no significant differences in arch dimensions between cleft and non cleft groups.

The present study indicated that the cleft individuals had smaller anterior Cranial base length (SN); Short Mandibular body length (Go-Gn); Short Mandibular overall length (Co-Gn); Short Ramus height (Co-Go); Obtuse Gonial angle, steep Mandibular plane; Reduced posterior facial height, increased anterior facial height, Mandible rotating downwards and backwards and Midface deficiency (SNA) when compared to non cleft individuals.

Horswell and Lavent (1988)¹⁴ evaluated craniofacial growth in UCLP patients and reported reduced maxillary arch length in cleft individuals. Blanco, Brece et al., (1989)¹⁵ also showed significant reduction in all the arch dimensions in cleft palate patients. Omar Gabriel, Camargo et al (1992)¹⁶ in their study on the influence of cleft on maxillary arch morphology, concluded that maxillary arch is distorted in the presence of cleft. Similar results were also reported by Heidbuchel, Jagtmanet al¹⁷ in 1997.

The data obtained from the present study may be used as an aid in diagnosis and treatment planning and also as a standard guide for Surgical and/ or Orthodontic interventions for Cleft individuals.

Conclusion

Significant variations are observed in Dental and Craniofacial form in Untreated Adult UCLPindividuals when compared to non cleft individuals. Facial characteristics were significantly different in sagittal plane when compared to that in the transverse plane. Significant differences were also observed in the dental characteristics between the untreated adult UCLP individuals and the non cleft individuals.

Further studies need to be carried out on different types of oro-facial clefts taking into account age and ethnicity of the individuals. Such investigations need to be conducted on a longitudinal basis to study the effects of cleft on the growth and development of the individual.