A morphometric assessment of the nasopharynx was carried out on 194 X-ray films of adult males with cleft lip and/or palate. According to the type and extent of the cleft they were subdivided into seven groups and compared with a control group of 50 normal males matched in age. The findings showed a reduction of the nasopharyngeal airway in all groups with cleft palate, which corresponded to the decrease in depth of the nasopharyngeal bony framework without participation of soft tissues. In cleft lip and palate the decrease was due exclusively to the posterior displacement of the maxilla, in isolated cleft palate it was due to several factors and was less marked. The height of the bony nasopharynx and the thickness of the nasopharyngeal posterior wall tissues remained unchanged in all types of clefts. In cleft palate the length of the velum was always reduced with a slighter reduction of the height of the body of the sphenoid bone. No changes were found in cleft lip alone. Pharyngeal flap surgery failed to influence the anteroposterior position of the maxilla or nasopharyngeal parameters. The length of the soft palate was not changed after this procedure, but the velum was displaced in posterior direction and its distance from the pharyngeal posterior wall was significantly reduced. The reduction was so marked that it could limit the air flow capacity of the airways. In individuals without pharyngeal flap surgery the velum was displaced in the anterior direction and its position could be influenced by the pushback of the mandible.

Adult↗

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Facial growth and development in unilateral cleft lip and palate from the time of palatoplasty to the onset of puberty: a longitudinal study.

X-ray cephalometry was used for the assessment of facial growth and development from the time of palate surgery to the onset of puberty (from 5 to 11 years) in 24 boys with unilateral cleft lip and palate treated with primary periosteoplasty (at 8 months) and palatal pushback supplemented by pharyngeal flap surgery (at 5 years). The lowest growth showed the depth of the maxilla and the height of the upper lip. An increasing protrusion of the mandible and in particular the increasing retrusion of the maxilla resulted in a flattening of the face and in an impairment of sagittal jaw relations. However, it was possible to attain an improvement of overjet produced by a substantial increase of the proclination of upper incisors and of the alveolar process. There was a deterioration of the prominence of the upper lip. Anterior growth rotation was absent during the development of the face, though a rotation in both directions was quite common in individual cases. The steepness of the mandibular body, vertical jaw relations, and facial vertical proportions remained unchanged. As compared to the pubertal period, the growth and development differed only by a more marked proclination of the dentoalveolar component of the maxilla and by an improvement of overjet. Facial convexity and sagittal jaw relations deteriorated in more than 90% of the patients, the overjet only in 20%, yet the prominence of the lip in 70%. Facial convexity and sagittal jaw relations were not correlated with mandibular rotation but they affected the overjet and the prominence of the upper lip.(ABSTRACT TRUNCATED AT 250 WORDS)

Cephalometry↗