Three-Dimensional Analysis of Morphological Changes in the Maxilla of Patients with Cleft Lip and Palate

Abstract

Objective

Three-dimensional (3-D) morphological changes in the maxilla of patients with cleft lip and palate (CLP) have been recorded, mainly using two-dimensional cast analyses. Although these seem to be insufficient, no standardized 3-D method has been developed until now. In this study, accuracy, precision, and validity of a newly developed 3-D digital computer-aided procedure to visualize and metrically analyze the growth of the edentulous maxilla of infants with CLP have been evaluated.

Patients

The method was applied to 10 infants with complete unilateral CLP.

Interventions

Consecutive casts of the maxilla (1 week and 3, 6, and 12 months) of each patient were optically measured with a 3-D laser scanner. Following digitizing, the casts were computer reconstructed, aligned, and superimposed using specialized computer software. The distances between the surfaces were measured. Additionally, the surfaces were segmented perpendicular to the alveolar crest, the reference points being C1, C1′, C2, C2′, and I. The volumes of the resulting segments were determined and compared with one another.

Results

The newly developed analysis enables a visualization of the extent and direction of morphological changes in the maxilla of infants with CLP. With this method it is possible to quantify these changes of the volume of defined alveolar segments.

Conclusions

The 3-D analysis developed is an ideal tool for the examination of 3-D morphological changes in the edentulous maxilla of patients with CLP. The results will serve as the starting point for a longitudinal study on the efficacy of different methods, not only of presurgical infant orthopedics but also of surgical procedures.

Keywords

cleft lip and palate maxillary morphological changes presurgical infant orthopedics surfacing 3-D analysis

References

Bacher

, Göz

, Pham

, Bacher

, Werner

, Buchner

, Bacher

. 3-D analysis of cleft palate topology in newborn infants with reference to the cranial skeleton. Cleft Palate Craniofac J. 1998; 35: 379–395.

Berkowitz

, Krischer

, Pruzansky

. Quantitative analysis of cleft palate casts. Cleft Palate J. 1974; 11: 134–161.

Berkowitz

, Guillermo

, Lan

N.P.

. An Optical Profilometer—a new instrument for the three dimensional measurement of cleft palate casts. Cleft Palate Craniofac J. 1982; 19: 129–138.

Berkowitz

. A comparison of treatment results in complete bilateral cleft lip and palate using a conservative approach versus Millard-Latham PSOT procedure. Sem Orthodont. 1996a; 2: 169–184.

Berkowitz

, ed. Cleft lip and palate. Perspectives in management. Vol. 1. San Diego, London: Singular Publishing Group, Inc.; 1996b.

Bhatia

. 3-D automated measurement of the human palate. A new method. In: Kriens

, ed. What Is a Cleft Lip and Palate? A Multidisciplinary Update. Stuttgart: Thieme; 1989: 142–145.

Bitter

. Latham's appliance for presurgical repositioning of the protruded premaxilla in bilateral cleft lip and palate. J Craniomaxillofac Surg. 1992; 20: 99–110.

Braumann

, Keilig

, Bourauel

, Jäger

. 3-D-modellanalyse des Oberkiefers von Säuglingen mit LKG-Spalten. Biomed Tech. 1999a; 44: 324–330.

Braumann

, Keilig

, Bourauel

, Niederhagen

, Jäger

. Three-dimensional analysis of cleft palate casts. Ann Anat. 1999b; 181: 95–98.

10.

Figueroa

A.A.

, Reisberg

D.J.

, Polley

J.P.

, Cohen

. Intraoral-appliance modification to retract the premaxilla in patients with bilateral cleft lip. Cleft Palate Craniofac J. 1996; 33: 497–500.

11.

Friede

, Katsaros

. Current knowledge in cleft lip and palate treatment from an orthodontist's point of view. J Orofac Orthop./Fortschr Kieferorthop. 1998; 59: 313–330.

12.

Graf-Pinthus

, Bettex

. Long-term observation following presurgical orthopedic treatment in complete clefts of the lip and palate. Cleft Palate Craniofac J. 1974; 24: 253–260.

13.

Henkel

K.O.

, Gundlach

K.K.

. Analysis of primary gingivoperiosteoplasty in alveolar cleft repair. Part I: facial growth. J Craniomaxillofac Surg. 1997; 25: 266–269.

14.

Honda

, Suzuki

, Ohishi

, Tashiro

. Longitudinal study on the changes of maxillary arch dimensions in Japanese children with cleft lip and/or palate: infancy to 4 years of age. Cleft Palate Craniofac J. 1995; 32: 149–155.

15.

Hotz

, Gnoinski

, Nussbaumer

, Kistler

. Early maxillary orthopedics in CLP cases: guidelines for surgery. Cleft Palate Craniofac J. 1978; 15: 405–415.

16.

Huang

M.H.S.

, Muoradian

W.E.

, Cohen

S.R.

, Gruss

J.S.

. The differential diagnosis of abnormal head shapes: separating craniosynostosis from positional deformities and normal variants. Cleft Palate Craniofac J. 1998; 35: 204–211.

17.

Huddart

A.G.

, Crabb

J.J.

. The effect of presurgical treatment on palatal tissue area in unilateral cleft lip and palate subjects. Br J Orthod. 1977; 4: 181–192.

18.

Koppenburg

, Schmelzle

, Bacher

, Dausch-Neumann

, Schwenzer

, Leidig

, Wolf

, Dagenbach

, Lindenmüller

. Frühversorgung und Wachstum des Säuglingsspaltkiefers. Fortschr Kieferorthop. 1986; 47: 391–399.

19.

Kriens

. Data-objective diagnosis of infant cleft lip alveolus and palate. Morphologic data guiding understanding and treatment concepts. Cleft Palate Craniofac J. 1991; 28: 157–168.

20.

Latham

R.A.

. Orthopedic advancement of the cleft maxillary segment: a preliminary report. Cleft Palate J. 1980; 17: 227–234.

21.

Mishima

, Sugahara

, Mori

, Sakuda

. Three-dimensional comparison between the palatal forms in complete unilateral cleft lip and palate with and without Hotz plate from cheiloplasty to palatoplasty. Cleft Palate Craniofac J. 1996a; 33: 312–317.

22.

Mishima

, Sugahara

, Mori

, Sakuda

. 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. 1996b; 33: 77–83.

23.

Moss

, Linney

, Grindrod

, Arridge

S.R.

, Clifton

J.S.

. Three dimensional visualization of the face and skull using computerized tomography and laser scanning techniques. Eur J Orthod. 1987; 9: 247–253.

24.

Oblak

. Trigonometric method of analysis of the upper part of the mouth cavity. J Maxillofac Surg. 1975; 3: 88–93.

25.

O'Donnell

J.P.

, Kirscher

J.P.

, Shiere

F.R.

. An analysis of presurgical orthopedics in the treatment of unilateral cleft lip and palate. Cleft Palate J. 1974; 11: 374–393.

26.

Papay

F.A.

, Morales

Jr. , Motoki

D.S.

, Yamashiro

D.K.

. Presurgical orthopedic premaxillary alignment in cleft lip and palate. Cleft Palate Craniofac J. 1994; 31: 494–497.

27.

Prahl

, Kuijpers-Jagtman

A.M.

, Prahl-Anderson

. Evaluation of maxillary arch dimensions. In: Kuijpers-Jagtman

A.M.

, Prahl

, eds. A Study into the Effects of Presurgical Orthodontic Treatment in Complete Unilateral Cleft Lip and Palate Patients. A Three Centre Prospective Clinical Trial in Nijmegen, Amsterdam and Rotterdam. Interim Analysis. Nijmegen, The Netherlands: University Press; 1996: 23–30.

28.

Pruzansky

. Factors determining arch form in clefts of lip and palate. Am J Orthod. 1955; 41: 827–851.

29.

Rosenstein

S.W.

. Two unilateral complete cleft lip and palate orthodontic cases treated from birth to adolescence. Am J Orthod Dentofacial Orthop. 1999; 115: 61–71.

30.

Ross

R.B.

. Treatment variables affecting facial growth in unilateral cleft lip and palate. Part 2: presurgical orthopaedics. Cleft Palate Craniofac J. 1987; 24: 24–32.

31.

Sarnäs

K.V.

, Rune

, Jacobsson

. The effect of passive plates on the arrangement of the alveolar arch segments in unilateral total cheilognathopalatoschisis [in German] Fortschr Kieferorthop. 1989; 50: 21–34.

32.

Seckel

N.G.

, van der Tweel

, Elema

G.A.

, Specken

TFJMC

. Landmark positioning on maxilla of cleft lip and palate infant—a reality? Cleft Palate Craniofac J. 1995; 32: 434–441.

33.

Shaw

W.C.

, Dahl

, Asher-McDade

, Brattstrom

, Mars

, McWilliam

, Molsted

, Plint

D.A.

, Prahl-Andersen

, Roberts

. A six-center international study of treatment outcome in patients with clefts of the lip and palate: Part 5. General discussion and conclusions. Cleft Palate Craniofac J. 1992; 29: 413–418.

34.

Sillman

J.H.

. Dimensional changes of the dental arches: longitudinal study from birth to 25 years. Am J Orthod. 1964; 50: 824–842.

35.

Stöckli

P.W.

. Application of a quantitative method for arch form evaluation in complete unilateral cleft lip and palate. Cleft Palate J. 1971; 8: 322–341.

36.

Winters

, Hurwitz

. Presurgical orthopedics in the surgical management of unilateral cleft lip and palate. Plast Reconstr Surg. 1995; 95: 755–764.