Plastic Surgery Research Council
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Presenter: Justine C Lee, MD, PhD
Co-Authors: Slack GC, Walker R; Martz MG; Graves L; Yen S; Woo J; Ambaram R; Kawamoto HK; Bradley JP

Background: Treatment of dental spaces in cleft lip and palate-related dental agenesis can be divided into three modalities: orthodontic dental space closure, dental space preservation with prosthethic placement, or dental space closure during orthognathic surgery. Although the need for orthognathic surgery is relatively common in cleft patients due to disease process and multiple surgical interventions during growth, one component of cleft care is to minimize the frequency for jaw surgery. In this study, we evaluate the contribution of orthodontic space closure to the incidence of maxillary hypoplasia and need for orthognathic surgery.

Methods: Unilateral cleft lip and palate, bilateral cleft lip and palate, and isolated cleft palate patients older than 15 years of age evaluated at the UCLA Craniofacial Clinic between 2008-2012 were retrospectively reviewed for dental anomalies and the subsequent orthodontic orthognathic treatment. Patients with additional craniofacial syndromes were excluded from the study.

Results: 95 cleft lip/palate or cleft palate patients were evaluated at or near skeletal maturity with an average age of 18.1 years (range 15-24). Congenital missing teeth occurred in 65 patients (66%), of which 30 patients demonstrated multiple missing teeth. Cleft patients with no missing teeth needed more Le Fort I advancements (20%) compared to cleft patients with at least one missing tooth (39%). Patients were stratified by treatment of dental gap: group 1 - preservation of dental gap (n=38) and group 2 - orthodontic closure of dental gap (n=28). In group 1, 55% of patients required orthognathic surgery for maxillary hypoplasia versus 89% in group 2.

Conclusions: The coordination of orthodontia and surgery are essential components of care for the cleft lip and palate patient. We report a strong correlation for cleft lip/palate patients who have received orthodontic closure of dental gaps and orthognathic surgery. We suggest that cleft-related dental space closure with orthodontia in a growing child may contribute to the severity of maxillary hypoplasia.

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