Čes. stomatol. Prakt. zub. lék. (Czech Dental Journal) 2000; 100(2)

Facial Growth and Development in Clefts of the Lip and/or Palate: Developmental Changes and their Impact on Treatment

Z. Šmahel¹, Ž. Müllerová²

¹ Ústav experimentální medicíny AV ČR, Praha

² Stomatologická klinika 3. LF UK, Praha

From the submitted review ensues that the main developmental problem of a face with a cleft palate is inadequate growth of the maxilla in an anterior direction and posteriorotation of the mandible. The facial growth type is characterized by a relatively small pubertal acceleration, more marked growth is apparent only in the mandible. In boys, contrary to girls, perceptible growth of the face can be observed also after the age of 15 years. This has important consequences for development. Deterioration of the occlusion during puberty is more due toexhaustion of compensatory adaptation capacities of the dentoalveolar component of the maxilla as a result of orthodontic therapy than to growth acceleration. Under such conditions the deterioration of sagittal intermaxillary relations can be compensated effectively to a certain extent by fixed appliances where restoration of overjet by proclination of the upper dentoalveolar component is an important mechanism for influencing (pushing back) the mandible. The most favourable developmental situation for the patient is a posterior shift of the mandible in the mandibular joint in combination with the rotational type within the neutral zone. Facial development is influenced also by the applied surgical method but the decisive factor for a favourable outcome of treatment is well conducted and effective orthodontic treatment. With regard to the considerable variability of development in clefts it must be strictly individual.

Keywords: cleft lip and palate; facial growth and development; compensatory mechanisms

Published: June 1, 2000  Show citation