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Lateral cephalometric radiographs from the growth archive of the Sri Lankan Cleft Lip and Palate Project were analyzed to elucidate the relationship between timing of hard palate repair and facial growth in patients with unilateral cleft lip and palate (UCLP). One hundred and twenty-five adult patients with nonsyndromic UCLP operated on at different ages for hard palate repair were recruited and their last cephalometric radiographs were used in the cross sectional analysis 104 patients with nonsyndromic UCLP operated on at different ages for hard palate repair and their 290 cephalometric radiographs were available in the longitudinal analysis. The design utilized statistical control for gender, age, and other covariates such as the timing and surgeon of lip repair as well as the technique and surgeon of hard palate repair. Results showed that the length of the alveolar maxilla (PMP-A, p = 0.05) and the anteroposterior alveolar jaw relation (ANB, p 0.05), were related to the timing of hard palate repair. These results suggest that in patients with UCLP late hard palate repair has a smaller adverse effect than early hard palate repair on the forward growth of the maxilla, and that timing of hard palate repair does not significantly affect the growth of the mandible.

The aim of this study was to determine the optimal format for presenting the 5-year olds' Index reference and patient dental models, for the assessment of dental arch relationships in unilateral cleft lip and palate (UCLP). The research was essentially undertaken in two parts. The first part, to assess the effect the presentation of the reference models has on the reliability and reproducibility of the 5-year olds' Index scores. Reference models were presented in four different formats; plaster models, coloured acrylic models and two digital formats which included three-dimensional digital models (3D) and black & white photographs. These formats were used to categorise plaster models of patients born with UCLP. The second part set out to determine the effect of the presentation of the sample format on the reliability and reproducibility of the 5-year olds' Index scores. Patient models were presented in both 3D digital and plaster models and scored using the reference models in the same two formats as the patient models. The same examiners were used in both parts of the investigation, which comprised experienced and inexperienced examiners. The level of agreement for the digital formats of the 5-year olds' Index was good to very good with the less experienced examiners, in general, demonstrating lower kappa values compared to the experienced examiners. Scoring the 3D digital patient models with the 5-year olds' Index in the same format was associated with a learning curve with general improvements in scores noted on the second occasion. Overjet measure was reported as the most difficult parameter to assess using the 3D digital models followed by assessment of buccal crossbites.

Differential growth was demonstrated between facial features and within some facial features. In particular, the columella, nostrils and philtrum did not grow significantly after surgery, although this would be considered normal in the age group studied. Facial growth in children with UCL and UCLP was independent of the head and body growth. The presence of a cleft of the secondary palate accentuated the amount of soft tissue disruption by the cleft in the lip and nose, but not the pattern of disruption. Primary lip / nose repair had no detrimental effect on the early growth and development of the facial features. Likewise, palate repair had no discernible effect on facial soft tissue growth at age 2 years. Primary lip /nose repair had a beneficial effect on facial morphology in terms of reducing asymmetry and was most successful in the improving philtrum and nasal base symmetry, less successful in improving the nasal rim asymmetry. A possible early beneficial effect of cleft repair remote from the surgery site was noted in the reduction of upper face asymmetry in the first year of life. Residual asymmetry in the facial features did not change by age 2 years, despite increases in size with growth. Facial morphology outcomes for UCL and UCLP children in this study was generally similar at 2 years of age, despite marked differences in pre-operative facial form. However, nasal base asymmetry, upper face asymmetry and residual nostril shape deformity were significantly greater in UCLP children at 2 years of age, than in UCL children. These shape differences were not detectable by measurement of facial dimensions alone.