Cleft Size and Maxillary Arch Dimensions in Unilateral Cleft Lip and Palate and Cleft Palate

76 Pages·2011·3.06 MB·English

by  Erika Reiser

To my parents Ingrid and Fred
iii

List of Papers
This thesis is based on the following papers, which are referred to in the text
by their Roman numerals.

I Reiser E, Skoog V, Gerdin B, Andlin-Sobocki A. Association
between cleft size and crossbite in children with cleft palate and
unilateral cleft lip and palate. Cleft Palate Craniofac J.
2010;47:175-181.
II Reiser E, Skoog V, Andlin-Sobocki A. Early dimensional
changes in maxillary cleft size and arch dimensions of children
with cleft lip and palate and cleft palate. Cleft Palate Craniofac
J. 2011. Accepted.
III Reiser E, Svee A, Andlin-Sobocki A. Facial growth in unilateral
cleft lip and palate and cleft palate: associations with maxillary
dimensions and cleft size in infancy. Submitted.
IV Reiser E, Andlin-Sobocki A, Mani M, Holmström M. Initial
size of cleft does not correlate with size and function of nasal
airway in adults with unilateral cleft lip and palate. J Plast Surg
Hand Surg. 2011;45:129-135.
Reprints were made with permission from the respective publishers.

Contents
Introduction ................................................................................................... 11
Embryology .............................................................................................. 11
Etiology .................................................................................................... 12
Epidemiology ........................................................................................... 12
Classification ............................................................................................ 13
Anatomy of UCLP and CP ....................................................................... 13
Treatment of clefts in Uppsala, Sweden ................................................... 15
Surgery ................................................................................................. 16
Infant orthopaedics and orthodontics ................................................... 17
Maxillary arch dimensions and occlusion ................................................ 18
Facial growth ............................................................................................ 19
Nasal airway size and function ................................................................. 20
Cleft size ................................................................................................... 21
Aims of the thesis.......................................................................................... 23
Materials and Methods .................................................................................. 24
Subjects Papers I to III ............................................................................. 24
Subjects Paper IV ..................................................................................... 25
Surgery ..................................................................................................... 26
Methods .................................................................................................... 27
Dental cast measurements .................................................................... 27
Crossbite scoring ................................................................................. 28
Cephalometrics .................................................................................... 29
Nasal airway size and function ............................................................ 31
Reliability of the methods ........................................................................ 32
Dental cast measurements .................................................................... 32
Cephalometric measurements .............................................................. 32
Statistical analyses .................................................................................... 32
Paper I .................................................................................................. 32
Paper II ................................................................................................ 33
Paper III ............................................................................................... 33
Paper IV ............................................................................................... 34
Results ........................................................................................................... 35
Cleft size and crossbite (Paper I) .............................................................. 35
Changes in cleft size and maxillary arch dimensions (Paper II) .............. 37
Maxillary arch dimensions, cleft size, and facial growth (Paper III) ....... 41
Cleft size and nasal function (Paper IV) .................................................. 43
Discussion ..................................................................................................... 45
Materials and Methods ............................................................................. 45
Cleft size and crossbite (Paper I) .............................................................. 47
Changes in cleft size and maxillary arch dimensions (Paper II) .............. 48
Maxillary arch dimensions, cleft size, and facial growth (Paper III) ....... 50
Cleft size and nasal function (Paper IV) .................................................. 51
General discussion .................................................................................... 52
Clinical implications ................................................................................ 53
Conclusions ................................................................................................... 55
Populärvetenskaplig sammanfattning på svenska ......................................... 56
Acknowledgements ....................................................................................... 58
References ..................................................................................................... 60
Abbreviations
AR Acoustic rhinometry
BCLP Bilateral cleft lip and palate
CB Crossbite
CL Cleft lip
CLP Cleft lip and palate
CP Cleft palate
CPo Cleft palate only
ICC Intra-class correlation coefficient
MCA 1 Minimal cross sectional area, ante-
rior part of the nose
(0 - 2.2 cm from nostril rim)
MCA 2 Minimal cross sectional area, post-
erior part of the nose
(2.2 - 5.4 cm from nostril rim)
mm millimetres
INSP Nasal Airway Resistance during
Inspiration
PNIF Peak nasal inspiratory flow
PRS Pierre Robin sequence
RM Rhinomanometry
SD Standard deviation
SOIT Scandinavian Odor Identification
Test
UCLP Unilateral cleft lip and palate
Vol 1 Nasal volume, anterior part of the
nose (0 - 2.2 cm from nostril rim)
Vol 2 Nasal volume, posterior part of the
nose (2.2 - 5.4 cm from nostril rim)
3D Three-dimensional

Additional abbreviations are explained in the associated text or figures.