Evaluation of Presurgical Oral Orthopedics vs. Conventional Taping in Management of Infants With Complete Cleft Lip and Palate; A Comparative Study

Abstract

The aim of this study was to evaluate treatment outcomes of presurgical oral orthopedics versus the conventional taping method in the management of infants with complete cleft lip and palate. Fifty eight Egyptian infants having complete CLP were included in the study. They were divided into two major groups; BCLP and UCLP Groups. The BCLP Group was further divided into PSOT Group and Control Group CB. The PSOT Group was subdivided into Group R and Group D according to the premaxillary characteristics. Therefore, the BCLP study groups were three equal Groups; Group R (n=9), Group D (n=10), and Group CB (n=10). PSOT was performed on Groups R and D by means of an intraoral screw-activated retrusion plate, while Group CB acted as a control group receiving only facial binding by surgical tape application. A study model was performed for every infant in all three study groups at start of treatment T1, after PSOT and just before surgical lip repair T2, one month post lip repair surgery T3, three months post T4, six months post T5, and one year post lip repair surgery T6. Changes in premaxillary anteroposterior position, anterior cleft width, intercanine, and posterior arch widths were measured three-dimensionally for each group at all treatment periods. Descriptive statistics for all variables during different time frames were calculated. Paired comparison t-test was used to compare between treatment periods within study groups, and student t-test was used to compare between the different groups in the study. The results showed during the overall treatment period (from T6 to T1), PSOT Groups showed significant retraction of the premaxilla greater than the Control Group. Group R showed significant higher reduction than Group D. Intercanine width and posterior arch width showed significant reduction in Group R but this reduction was nonsignificant when comparing the other PSOT Group; Group D to Control Group CB suggesting a different reaction of Group R to PSOT specific to its bone quality. The UCLP Group was further divided into PSOT Group and Control Group CU. The PSOT Group was subdivided into Group J and Group F according to the type of PSOT appliance used. Infants were randomly distributed between these two groups. The UCLP study groups therefore were three equal Groups; Group J (n=9), Group F (n=10), and Group CU (n=10). PSOT was performed on Groups J and F by means of an intraoral screw-activated acrylic plate; Group J received a unidirectional jackscrew while Group F received a fan shaped screw. The Group CU acted as a control group receiving only facial binding by surgical tape application. A study model was performed for every infant in all three study groups at start of treatment T1, after PSOT and just before surgical lip repair T2, one month post lip repair surgery T3, three months post T4, six months post T5, and one year post lip repair surgery T6. Changes in anterior cleft width, middle cleft width, intercanine width, posterior arch width and rotational changes of the cleft segments were obtained on three dimensional virtual study models. Descriptive statistics for all variables during different time frames were calculated. Paired comparison t-test was used to compare between treatment periods within study groups, and student t-test was used to compare between the different groups in the study. The results during the overall treatment period (from T6 to T1) showed a significant reduction of anterior cleft width, middle cleft width, and intercanine arch width in PSOT Groups than Control Group CU. The jackscrew showed greater reduction in anterior and middle cleft widths than the fan shaped screw. From the results obtained, it could be generally concluded that; 1. PSOT is an efficient method of reducing anteroposterior and transverse deformity in both BCLP and UCLP infants when compared to the conventional taping method and showed sustainability of these findings up to one year post lip repair surgery. 2. These effects of PSOT on wide clefts had significant impact on the surgical, esthetic and functional outcome of surgical lip repair. 3. The effects of PSOT were sustainable in both BCLP and UCLP up to one year post-surgical lip repair. 4. Surgical teams reported difficulty in surgical lip repair of the BCLP and UCLP Control Groups due to the wide deformity that lead to unesthetic scarring and extensive tension at the surgical site.