Korean J Orthod.  2021 Jan;51(1):43-54. 10.4041/kjod.2021.51.1.43.

Cephalometric predictors of future need for orthognathic surgery in Korean patients with unilateral cleft lip and palate despite long-term use of facemask with miniplate

• Yu SH
• Baek SH
• Choi JY
• Lee JH
• Kim S
• On SW

• KMID: 2510617
• DOI: http://doi.org/10.4041/kjod.2021.51.1.43

Abstract

Objective
To investigate the cephalometric predictors of the future need for orthognathic surgery in Korean patients with unilateral cleft lip and palate (UCLP) despite long-term use of facemask with miniplate (FMMP).
Methods
The sample consisted of 53 UCLP patients treated by a single orthodontist using an identical protocol. Lateral cephalograms were taken before commencement of FMMP therapy (T0; mean age, 10.45 years), after FMMP therapy (T1; mean age, 14.72 years), and at follow-up (T2; mean age, 18.68 years). Twenty-eight cephalometric variables were measured. At T2 stage, the subjects were divided into FMMP-Nonsurgery (n = 33, 62.3%) and FMMP-Surgery (n = 20, 37.7%) groups according to cephalometric criteria (point A-nasion-point B [ANB] < –3°; Wits-appraisal < –5 mm; and Harvold unit difference [HUD] > 34 mm for FMMP-Surgery group). Statistical analyses including discrimination analysis were performed.
Results
In FMMP-Surgery group, the forward position of the mandible at T0 stage was maintained throughout the whole stages and Class III relationship worsened with significant growth of the mandibular body and ramus and counterclockwise rotation of the maxilla and mandible at the T1 and T2 stages. Six cephalometric variables at T0 stage including ANB, anteroposterior dysplasia indicator, Wits-appraisal, mandibular body length, HUD, and overjet were selected as effective predictors of the future need for surgical intervention to correct sagittal skeletal discrepancies.
Conclusions
Despite long-term use of FMMP therapy, 37.7% of UCLP patients became candidates for orthognathic surgery. Therefore, differential diagnosis is necessary to predict the future need for orthognathic surgery at early age.

Keyword

Unilateral cleft lip and palate; Cephalometric predictors; Orthognathic surgery; Facemask with miniplate

Figure

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  Figure 1 Serial lateral cephalograms taken before facemask with miniplate (FMMP) therapy (T0), after FMMP therapy (T1), and follow-up (T2) in the FMMP-Nonsurgery group (A) and FMMP-Surgery group (B).

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  Figure 2 An example of installation of two additional miniplates on the mandibular symphysis and use of Class III elastics between the maxillary and mandibular miniplates at day time and facemask with miniplate at night time.

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