Skip to main content
SpringerLink
Log in

Maxillary reaction patterns identified by three-dimensional analysis of casts from infants with unilateral cleft lip and palate

Reaktionsmuster des Oberkiefers von Säuglingen mit einseitigen Lippen-Kiefer-Gaumen-Spalten nach 3-D-Modellanalyse

  • Original article
  • Published:
Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie Aims and scope Submit manuscript

Abstract

Objectives

In order to visualize and quantify the direction and extent of morphological upper-jaw changes in infants with unilateral cleft lip and palate (UCLP) during early orthodontic treatment, a three-dimensional method of cast analysis for routine application was developed. In the present investigation, this method was used to identify reaction patterns associated with specific cleft forms.

Materials and methods

The study included a cast series reflecting the upper-jaw situations of 46 infants with complete (n=27) or incomplete (n=19) UCLP during week 1 and months 3, 6, and 12 of life. Three-dimensional datasets were acquired and visualized with scanning software (DigiModel®; OrthoProof, The Netherlands). Following interactive identification of landmarks on the digitized surface relief, a defined set of representative linear parameters were three-dimensionally measured. At the same time, the three-dimensional surfaces of one patient series were superimposed based on a defined reference plane. Morphometric differences were statistically analyzed.

Results

Thanks to the user-friendly software, all landmarks could be identified quickly and reproducibly, thus, allowing for simultaneous three-dimensional measurement of all defined parameters. The measured values revealed that significant morphometric differences were present in all three planes of space between the two patient groups. Patients with complete UCLP underwent significantly larger reductions in cleft width (p<0.001), and sagittal growth in the complete UCLP group exceeded sagittal growth in the incomplete UCLP group by almost 50% within the first year of life.

Conclusion

Based on patients with incomplete versus complete UCLP, different reaction patterns were identified that depended not on apparent severities of malformation but on cleft forms.

Zusammenfassung

Zielsetzung

Um Richtung und Ausmaß morphologischer Veränderungen des Oberkiefers von Säuglingen mit Lippen-Kiefer-Gaumen-Spalten (LKGS) unter kieferorthopädischer Frühbehandlung visuell erfassen und quantifizieren zu können, wurde eine für die routinemäßige Anwendung geeignete dreidimensionale Modellanalyse entwickelt. Das Ziel war die Extraktion von Reaktionsmustern in Abhängigkeit von der Spaltform.

Material und Methoden

Aus 46 Oberkiefermodellserien (1. Lebenswoche, 3., 6. und 12. Lebensmonat) von Säuglingen mit einseitig totalen (n=27) bzw. einseitig partiellen LKGS (n=19) wurden dreidimensionale Datensätze akquiriert und mit der Software DigiModel® (OrthoProof, Nieuwegein, Niederlande) visualisiert. Anschließend wurden Referenzpunkte auf dem Oberflächenrelief interaktiv identifiziert sowie repräsentative Streckenmessungen definiert und dreidimensional vermessen. Gleichzeitig wurden die digitalisierten Modelloberflächen eines Patienten in einer definierten Referenzebene überlagert. Morphometrische Unterschiede wurden statistisch geprüft.

Ergebnisse

Die einfache Handhabung der Software ermöglichte eine schnelle sowie reproduzierbare Identifikation aller Referenzpunkte und damit eine simultane dreidimensionale Vermessung aller definierten Parameter. Die Messwerte zeigten signifikante morphometrische Unterschiede in allen Raumebenen zwischen beiden Patientengruppen. Die Reduktion der Spaltbreite war bei totalen LKGS signifikant ausgeprägter (p<0,001). Innerhalb des ersten Lebensjahres war das sagittale Wachstum bei Patienten mit totalen LKGS gegenüber denen mit partiellen LKGS um nahezu 50% erhöht.

Schlussfolgerung

In Abhängigkeit von der Spaltform und nicht vom offensichtlichen Schweregrad der Fehlbildung war es möglich, unterschiedliche Reaktionsmuster für einseitig partielle und einseitig totale LKGS zu extrahieren.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

References

  1. Adali N, Mars M, Petrie A et al (2012) Presurgical orthopedics has no effect on archform in unilateral cleft lip and palate. Cleft Palate Craniofac J 1:5–13

    Article  Google Scholar 

  2. Aduss H, Pruzansky S (1968) Width of the cleft at level of the tuberosities in complete unilateral cleft lip and palate. Plast Reconstr Surg 41:113–123

    Article  PubMed  Google Scholar 

  3. Ashley-Montague MF (1934) The form and dimensions oft the palate in the newborn. Int J Orthod 20:649–704

    Google Scholar 

  4. Berkowitz S, Duncan R, Evans C et al (2005) Timing of cleft palate closure should be based on the ratio of the area of the cleft to that of the palatal segments and not on age alone. Plast Reconstr Surg 116:361

    Google Scholar 

  5. Berkowitz S, Guillermo G, Lan NP (1982) An optical profilometer—a new instrument for the three dimensional measurement of cleft palate casts. Cleft Palate Craniofac J 19:129–138

    Google Scholar 

  6. Berkowitz S, Krischer J, Pruzansky S (1974) Quantitative analysis of cleft palate casts. Cleft Palate J 11:134–161

    PubMed  Google Scholar 

  7. Bhatia S (1989) Three-dimensional automated measurement of the human palate. A new method. In: Kriens O (ed) What is a cleft lip and palate? A multidisciplinary update. Thieme, Stuttgart, pp 142–145

  8. Boldt F, Weinzierl C, Hertrich K et al (2009) Comparison of the spatial landmark scatter of various 3D digitalization methods. J Orofac Orthop 70(3):247–263

    Article  PubMed  Google Scholar 

  9. Bongaarts CAM, Prahl-Andersen B, Bronkhorst EM et al (2009) Infant orthopedics and facial growth in complete unilateral cleft lip and palate until 6 years of age (Dutchcleft). Cleft Palate Craniofac J 46:654–663

    Article  PubMed  Google Scholar 

  10. Brattström V, Mølsted K, Prahl-Andersen B et al (2005) The Eurocleft study: intercenter study of treatment outcome in patients with complete cleft lip and palate. Part 2: craniofacial form and nasolabial appearance. Cleft Palate Craniofac J 42:69–77

    Article  PubMed  Google Scholar 

  11. Braumann B, Keilig L, Bouraul C et al (2002) A Three dimensional analysis of morphological changes in the maxilla of patients with cleft lip and palate. Cleft Palate-Craniofac J 39(1):1–11

    Google Scholar 

  12. Braumann B, Keilig L, Stellzig-Eisenhauer A et al (2003) Patterns of maxillary alveolar arch growth changes of infants with unilateral cleft lip and palate: preliminary findings. Cleft Palate-Craniofacl J 40(4):363–372

    Google Scholar 

  13. Braumann B, Rosenhayn S, Bourauel C et al (2001) Two- or three-dimensional cast analysis in patients with cleft lip and palate? J Orofac Orthop/Fortschr Kieferorthop 62:451–465

    Google Scholar 

  14. Chiu Y-T, Liao Y-F, Chen P K-T (2011) Initial cleft severity and maxillary growth in patients with complete unilateral cleft lip and palate. Am J Orthofacial Orthop 40:189–95

    Google Scholar 

  15. Dogan S, Öncag G, Akin Y (2005) Craniofacial delelopment in children with unilateral cleft lip and palate. Br J Oral Maxillofac Surg 44:28–33

    Article  PubMed  Google Scholar 

  16. Friede H (1998) Growth sites and growth mechanisms at risk in cleft lip and palat. Acta Odontol Cand 56:346–351

    Article  Google Scholar 

  17. Friede H, Enemark H (2001) Long-term evidence for favorable midfacial growth after delayed hard palate repair in UCLP patients. Cleft Palate Craniofac J 38:323–329

    Article  PubMed  Google Scholar 

  18. Friede H, Katsaros C (1998) Current knowledge in cleft lip and palate treatment from an orthodontist’s point of view. J Orofac Orthop/Fortschr Kieferorthop 59:313–329

    Google Scholar 

  19. Holst IA, Holst S, Nkenke E et al (2009) Vertical and sagittal growth in patients with unilateral and bilateral cleft lip and palate—a retrospective cephalometric evaluation. Cleft Palate Craniofac J 46:512–520

    Article  PubMed  Google Scholar 

  20. Hotz MM (1969) Pre- and early postoperative growth-guidance in cleft lip and palate cases by maxillary orthopedics (an alternative procedure to primary bone-grafting). Cleft Palate J 6:368–372

    PubMed  Google Scholar 

  21. Huddart AG, MacCauley FJ, Davis ME (1969) Maxillary arch dimensions in normal and unilateral cleft palate subjects. Cleft Palate J 6:471–487

    PubMed  Google Scholar 

  22. Ivy RH (1968) Congenital deformities reported on birth certificates in Pennsylvania, 1961–65: with special reference to racial influence on incidence. Plast Reconstr Surg 41:50–53

    Article  PubMed  Google Scholar 

  23. Kramer GJC, Hoeksma JB, Prahl-Andersen B (1992) Early palatal changes in complete and incomplete cleft lip and/or palate. Acta Anat 144:202–212

    Article  PubMed  Google Scholar 

  24. Kriens O (1991) Data-objective diagnosis of infant cleft lip alveolus and palate. Morphologic data guiding understanding and treatment concepts. Cleft Palate Cranifac J 28:157–168

    Article  Google Scholar 

  25. Kuijpers-Jagtman AM (1989) Model analysis comparison of BCLP data and Leighton-data measured with the Optocom. In: Kriens O (ed) What is a cleft lip and palate? A multidisciplinary update.Thieme, Stuttgart, pp 137–139

  26. Li Y, Shi B, Song Q-G, Zuo H et al (2006) Effects of lip repair on maxillary growth and soft tissue development in patients with a complete unilateral cleftof lip, alveolus and palate. J Cranio-Maxillofacial Surg 34:355–361

    Google Scholar 

  27. Liao Y-F, Prasad NKK, Chiu Y-T et al (2010) Cleft size at the time of palate repair in complete unilateral cleft lip and palate as an indicator of maxillary growth. Int J Oral Maxillofac Surg 39:956–961

    Article  PubMed  Google Scholar 

  28. Liao YF, Mars M (2006) Hard palate repair timing and facial growth in cleft lip and palate: a systematic review. Cleft Palate Craniofac J 43:563–570

    Article  PubMed  Google Scholar 

  29. Marques IL, Nackashi JA, Borgo HC et al (2009) Longitudinal study of growth of children with unilateral cleft-lip palate from birth to 2 years of age. Cleft Palate Craniofac J 46:603–609

    Article  PubMed  Google Scholar 

  30. Mishima K, Sugahara T, Mori Y et al (1996) Three-dimensional comparison between the palatal forms in infants with complete unilateral cleft lip alveolus and palate (UCLP) with and without Hotz’s plate. Cleft Palate Craniofac J 33:77–83

    Article  PubMed  Google Scholar 

  31. Mishima K, Sugahara T, Mori Y et al (1998) Effects of presurgical orthopedic treatment in infants with complete bilateral cleft lip and palate. Cleft Palate Craniofac J 35:227–232

    Article  PubMed  Google Scholar 

  32. Mølsted K, Brattström V, Prahl-Andersen B et al (2005) The Eurocleft study: intercenter study of treatment outcome in patients with complete cleft lip and palate. Part 3: dental arch relationships. Cleft Palate Craniofac J 42:78–82

    Article  PubMed  Google Scholar 

  33. Opitz C, Kratzsch H (1997) Oberkieferdimension bei ein- und doppelseitiger Lippen-Kiefer-Gaumen-Spalte. J Orofac Orthoped 58:110–123

    Google Scholar 

  34. Oplak P (1975) Trigonometric method of analysis of the upper part of the mouth cavity. J Max Fac Surg 3:88–93

    Article  Google Scholar 

  35. Peltomäki T, Venditelli BL, Grayson BH et al (2001) Associations between severity of clefting and maxillary growth in patients with unilateral cleft lip and palate treated with infant orthopedics. Cleft Palate Craniofac J 38:582–586

    Article  PubMed  Google Scholar 

  36. Pfeifer G (1966) Morphology of the formation of clefts as a basis for treatment. In: Schuchardt K (ed) Treatment of patients with clefts of lip, alveolus and palate. Thieme, Stuttgart, pp 14–24

  37. Pfeifer G (1986) Die Craniogenese aus teratologischer Sicht. Nova Acta Leopoldina 58:343–363

    Google Scholar 

  38. Prahl C, Kuijpers-Jagtman AM, Hof MA van’t (2001) A randomised prospective clinical trial into the effect of infant orthopaedics on maxillary arch dimensions in unilateral cleft lip and palate (Dutchcleft). Eur J Oral Sci 109:297–305

    Article  PubMed  Google Scholar 

  39. Prahl C, Prahl-Andersen B, Hof MA vant et al (2008) Presurgical orthopedics and satisfaction in motherhood: a randomized clinical trial (Dutchcleft). Cleft Palate Craniofac J 3:284–288

    Article  Google Scholar 

  40. Prasad CN, Marsh JL, Long RE Jr et al (2000) Quantitative 3D maxillary arch evaluation of two different infant managements for unilateral cleft lip and palate. Cleft Palate Craniofac J 37:562–570

    Article  PubMed  Google Scholar 

  41. Reiser E, Skoog V, Andlin-Sobocki (2011) A early dimensional changes in maxillary cleft size and arch dimensions of children with cleft lip and palate and cleft palate. Cleft Palate Craniofac J

  42. Richard B, Russel J, McMahon S et al (2006) Results of randomized controlled trial of soft palate first versus hard palate first repair in unilateral complete cleft lip and palate. Cleft Palate Craniofac J 43:329–338

    PubMed  Google Scholar 

  43. Seckel NG, Tweel I van der, Elema GA et al (1995) Landmark positioning on maxilla of cleft lip and palate infant—a reality? Cleft Palate Craniofac J 32:434–441

    Article  PubMed  Google Scholar 

  44. Semb G, Brattström V, Mølsted K et al (2005) The Eurocleft study: intercenter study of treatment outcome in patients with complete cleft lip and palate. Part 1: introduction and treatment experience. Cleft Palate Craniofac J 42:64–68

    Article  PubMed  Google Scholar 

  45. Shaw WC, Brattström V, Mølsted K et al (2005) The Eurocleft study: intercenter study of treatment outcome in patients with complete cleft lip and palate. Part 5: discussion and conclusions. Cleft Palate Craniofac J 42:93–98

    Article  PubMed  Google Scholar 

  46. Sillman JH (1938) Dimensional changes of the dental arches: longitudinal study from birth to 25 years. Am J Orthod 24:409–424

    Google Scholar 

  47. Stöckli PW (1971) Application of a quantitative method for arch from evaluation in complete unilateral cleft lip and palate. Cleft Palate J 8:322–341

    PubMed  Google Scholar 

  48. Tennison C (1952) The repair of unilateral cleft lip by the stencil method. Plast Reconstr Surg 9:115–120

    Article  Google Scholar 

  49. Uzel A, Alparslan ZN (2011) Long-Term effects of presurgical infant orthopedics in patients with cleft lip and palate: a systematic review. Cleft Palate Craniofac J 48:587–595

    Article  PubMed  Google Scholar 

  50. Wiggman K, Larson M, Larson O et al (2012) The influence of the initial width of the cleft in patients with unilateral cleft lip and palate related to final treatment outcome in the maxilla at 17 years of age. Eur J Orthod (Epub ahead of print)

  51. Winters JC, Hurwitz DJ (1995) Presurgical orthopedics in the surgical management of unilateral cleft lip and palate. Plast Reconstr Surg 95:755–764

    Article  PubMed  Google Scholar 

  52. Ysunza A, Pamplona Ma C, Quiroz J et al (2010) Maxillary growth in patients with complete cleft lip and palate, operated on around 4–6 month of age. Int J Pediatr Otorhinolaryngol 74:482–485

    Article  PubMed  Google Scholar 

  53. Zemann W, Mossböck R, Kärcher H et al (2007) Sagittal growth of the facial skeleton of 6-year-old children with a complete unilateral cleft of lip, alveolus and palate treated with two different protocols. J Cranio-Maxillofacial Surg 35:343–349

    Google Scholar 

Download references

Conflict of interst

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Department of Orthodontics, University of Cologne Medical School, Kerpener Str. 32, 50931, Cologne, Germany

    J. Neuschulz, I. Schaefer & B. Braumann

  2. Department of Oral and Maxillofacial Plastic Surgery, University of Cologne Medical School, Cologne, Germany

    M. Scheer

  3. Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne Medical School, Cologne, Germany

    H. Christ

Authors
  1. J. Neuschulz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. I. Schaefer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Scheer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Christ
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. B. Braumann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Neuschulz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Neuschulz, J., Schaefer, I., Scheer, M. et al. Maxillary reaction patterns identified by three-dimensional analysis of casts from infants with unilateral cleft lip and palate. J Orofac Orthop 74, 275–286 (2013). https://doi.org/10.1007/s00056-013-0153-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00056-013-0153-0

Keywords

Schlüsselwörter

Search

Navigation