Craniofacial development after three different palatoplasties in children born with isolated cleft palate

Introduction: Different palatoplasties are applied for the surgical correction of children born with an isolated cleft in the palate (ICP). During the last decades the Veau-Wardill-Kilner (VWK), Minimal Incision (MI) and Minimal Incision with radical muscle reconstruction (MMI) palatoplasties were performed by the Stockholm Craniofacial Team. Aims: To compare the VWK, MI and MMI techniques for repair of isolated clefts of the soft and/or hard palate regarding surgical complications, dentoalveolar outcome at 5 years, facial growth at 5 and 10 years, and to compare patients with ICP with children born without a cleft at 10 and 16 years of age. Materials: A consecutive series of 247 Caucasian non-syndromic children born with isolated cleft palate between 1980 and 2007 and treated surgically at 13 months were studied. Children with Pierre Robin Sequence (PRS) were included in the study. The patients were divided into six groups: three groups regarding the three surgical techniques and two groups regarding cleft length (extending in the soft, or hard and soft palate). A control group of 55 children (25 boys and 30 girls) without a cleft registered at 10 years and another 55 (25 boys and 30 girls) at 16 years of age was used. Methods: Retrospective study of A. medical records of patients treated with MI or MMI concerning time for surgery, blood loss, complications in the immediate postoperative period, frequency of fistulas and additional pharyngeal flap surgery; B. study models of patients treated with MI or MMI at 5 years concerning dental relations, structure of the palatal mucosa, and height of the palatal vault; C1. lateral cephalograms of patients treated with VWK, MMI or MMI at 5, 10 and 16 years of age calculating fourteen skeletal and one soft tissue measurement; C2. lateral cephalograms of patients born without a cleft at 10 and 16 years calculating fourteen skeletal and one soft tissue measurement. Results: A. surgical complications. The MMI, compared to the MI, technique resulted in statistically significant increased operation time, less need for pharyngeal flaps, and to shallower palatal vault. Big clefts result in statistically significant increased operation time and need for pharyngeal flaps. B. dentoalveolar outcome. Dental relations and the structure of the palatal mucosa were the same in all groups. The palatal height was reduced in the MMI group distal of the first primary molars. C1. facial growth. Only minor differences in cephalometric mo