Development of Palatal Growth Charts for Unilateral Cleft Lip and Palate Before Primary Single-Stage Repair

Abstract

Objective: We study changes in palatal morphology under presurgical passive plate therapy (PSPPT) in patients with unilateral cleft lip and palate (UCLP) from birth to single-stage cleft lip and palate repair. The primary aim was to model a growth chart for palatal surface area, in order to generate a reference for individual growth prediction and surgical planning. The secondary aim was to quantify and evaluate morphological changes in the palate using measurements on 3-dimensional (3D) intraoral surface models. Design: Retrospective cohort study. Setting: Tertiary care university hospital. Patients: We analyzed 3D models from intraoral scans and digitized plaster casts of 30 patients with UCLP undergoing PSPPT in their first year of life. Main Outcome Measures: We measured areas (palatal surface, projected palatal size, greater and lesser segments), angles (premaxillary/lesser segment rotation), transversal distances (intercanine, intertuberosity, premaxilla, cleft width), and maxillary sagittal length, using 3D software and analyzed the data with linear mixed-effects and nonlinear models. Results: The palatal width measured between the canines and tuberosities was unaffected by age, whereas the palatal surface area, premaxillary width and maxillary length increased with age. The premaxilla became more centered, and the anterior cleft width decreased consistently during treatment, despite a notable variation in the starting levels. Conclusions: Despite significant variations in baseline palatal size and morphology, the growth rate across all dimensions was consistent among individuals. This suggests that individual palatal growth morphology can be inferred from growth charts, allowing monitoring and prediction of cleft palate development for subsequent surgical planning and timing.