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

Overview

Summary:
From the submitted review ensues that the main developmental problem of a facewith a cleft palate is inadequate growth of the maxilla in an anterior direction and posterioro-tation of the mandible. The facial growth type is characterized by a relatively small pubertalacceleration, 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 importantconsequences for development. Deterioration of the occlusion during puberty is more due toexhaustion of compensatory adaptation capacities of the dentoalveolar component of themaxilla as a result of orthodontic therapy than to growth acceleration. Under such conditionsthe deterioration of sagittal intermaxillary relations can be compensated effectively to a certainextent by fixed appliances where restoration of overjet by proclination of the upper dentoalve-olar component is an important mechanism for influencing (pushing back) the mandible. Themost 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. Facialdevelopment is influenced also by the applied surgical method but the decisive factor fora favourable outcome of treatment is well conducted and effective orthodontic treatment. Withregard to the considerable variability of development in clefts it must be strictly individual.

Key words:
cleft lip and palate – facial growth and development – compensatory mechanisms