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Maxillary shape after primary cleft closure and before alveolar bone graft in two different management protocols: A comparative morphometric study

Article dans une revue avec comité de lecture
Author
GIRINON, François
1001017 Institut de Biomécanique Humaine Georges Charpak [IBHGC]
KETOFF, Serge
1001017 Institut de Biomécanique Humaine Georges Charpak [IBHGC]
HENNOCQ, Quentin
414766 CHU Necker - Enfants Malades [AP-HP]
KOGANE, Nicolas
414766 CHU Necker - Enfants Malades [AP-HP]
ULLMANN, Nicolas
414766 CHU Necker - Enfants Malades [AP-HP]
KADLUB, Natacha
414766 CHU Necker - Enfants Malades [AP-HP]
GALLIANI, Eva
414766 CHU Necker - Enfants Malades [AP-HP]
NEIVA-VAZ, Cécilia
414766 CHU Necker - Enfants Malades [AP-HP]
VASQUEZ, Marie-Paule
414766 CHU Necker - Enfants Malades [AP-HP]
PICARD, Arnaud
414766 CHU Necker - Enfants Malades [AP-HP]
KHONSARI, Roman Hossein
414766 CHU Necker - Enfants Malades [AP-HP]

URI
http://hdl.handle.net/10985/18318
DOI
10.1016/j.jormas.2019.02.001
Date
2019
Journal
Journal of Stomatology, Oral and Maxillofacial Surgery

Abstract

AIM AND SCOPE: Result assessment in cleft surgery is a technical challenge and requires the development of dedicated morphometric tools. Two cohorts of patients managed according to two different protocols were assessed at similar ages and their palatal shape was compared using geometric morphometrics. MATERIAL AND METHODS: Ten patients (protocol No. 1) benefited from early lip closure (1-3 months) and secondary combined soft and hard palate closure (6-9 months); 11 patients (protocol No. 2) benefited from later combined lip and soft palate closure (6 months) followed by hard palate closure (18 months). Cone-Beam Computed Tomography (CBCT) images were acquired at 5 years of age and palatal shapes were compared between protocols No. 1 and No. 2 using geometric morphometrics. RESULTS: Protocols No. 1 and No. 2 had a significantly different timing in their surgical steps but were assessed at a similar age (5 years). The inter-canine distance was significantly narrower in protocol No. 1. Geometric morphometrics showed that the premaxillary region was located more inferiorly in protocol No. 1. CONCLUSION: Functional approaches to cleft surgery (protocol No. 2) allow obtaining larger inter-canine distances and more anatomical premaxillary positions at 5 years of age when compared to protocols involving early lip closure (protocol No. 1). This is the first study comparing the intermediate results of two cleft management protocols using 3D CBCT data and geometric morphometrics. Similar assessments at the end of puberty are required in order to compare the long-term benefits of functional protocols.

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