[A contribution to the controversial discussion on a preoperative orthodontic treatment for infants with unilateral cheilognathopalatoschisis].
A longitudinal study of 39 casts of pre-operative orthodontically treated unilateral cleft lip and palate children from birth to palate operation was carried out with a special coordinate measuring technique to quantify changes in the maxilla. A significant reduction in width of the alveolar cleft was found. The anterior alveolar arch width remained constant, while the posterior region slightly increased. These results seem to justify treatment with the infant appliance. After measuring casts from 39 preoperatively treated and casts from 62 untreated patients prior to lip operation, a comparison of the mathematical average values between the two groups revealed few differences. This can be explained by referring to the original morphological findings and the different measurements during the preoperative orthodontic treatment, which lead to different changes in segment position prior to lip operation. In a cross section examination this difference could not be found. A sub-classification of the subject matter in primary and secondary clefts revealed that between both types clear differences in the resulting parameters can be observed. This leaves the question, whether the width of the cleft palate is caused by tissue deficiency or by an embedded tongue. Furthermore, how will the orthodontic appliance therapy influence the growth? A greater dislocation of the segments in secondary clefts may be expected in cases where the rest position of the tongue appears caudal. Improved measuring methods to record cleft morphology and more emphasis on the study of soft tissue reactions may help to understand the differing results after preoperative or orthodontic treatment.