Long Term Effect of Gingivoperiosteoplasty on Maxillary Development in Patients with Cleft Lip and Palate

Abstract

Cleft lip and palate is one of the most common congenital craniofacial anomalies, affecting approximately 1.42 per 1,000 live births in the United States. Significant progress has been made in understanding cleft lip and palate, but there remains no consensus on the ideal treatment protocol. Gingivoperiosteoplasty (GPP), which aims to create a mucoperiosteal bridge across the alveolar cleft, is a procedure that may be added at the time of the primary lip closure. A benefit of GPP is that it may decrease the chance of future alveolar bone grafting by creating a bony bridge between the segments before teeth erupt. Another benefit may be reduction in oronasal fistulas. However, it has been debated that the GPP procedure may restrict maxillary growth and create more severe malocclusions. In our study, 35 unilateral complete cleft lip and palate patients all treated in the same tertiary hospital with a Latham appliance and primary lip repair were examined. A Latham appliance is a device that is placed in patients with unilateral complete cleft lip and palate at 2-5 months old prior to both lip repair and GPP. It is used to align the upper jaw segments and reduce the width of the cleft. The non-GPP group consisted of 11 patients who received a Latham appliance prior to primary lip repair. The GPP group consisted of 24 patients who received both a Latham appliance prior to primary lip repair and the GPP procedure during the lip repair. CBCT radiographs were taken on all patients at 6-8 years and were used to measure the maxilla in all three planes of space. Lateral and posterior-anterior cephalograms were extracted from the CBCT and traced. The same researcher traced all cephalograms at two different time points. In the sagittal plane ANS-PNS, SNA, and A-N perpendicular were measured. In the vertical plane UFH: LFH was used. And in the transverse plane, Jugal-Jugal was measured. By comparing the two groups, we are able to analyze if the GPP procedure results in an increase in maxillary hypoplasia. Statistical analysis was completed using a t test to compare the means between the two groups. Statistical significance was defined as having a p value less than 0.05. The analysis revealed that there is no statistical significant increase in hypoplasia of the maxilla in the sagittal and vertical dimension, but there was a statistical significant difference in the transverse dimension measured by jugal-jugal. While the treatment of cleft lip and palate remains at discord, these results provide valuable insight that can be used for creating protocols and surgical strategies in treating patients with cleft lip and palate.