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OBJECTIVE: The purpose of this study was to evaluate and compare mandibular morphology and spatial position in children with complete unilateral cleft lip and palate (UCLP) treated at two different cleft centers (Hannover and Brussels) following different surgical treatment protocols. PATIENTS: A total of 62 Caucasian children (40 boys, 22 girls) with nonsyndromic complete unilateral cleft lip and palate (UCLP) were evaluated by means of conventional cephalometric analysis at approximately the age of 10 years. Data of both cleft groups were compared with a control, noncleft group (n = 40) matched according to age and sex. INTERVENTIONS: The Hannover children with cleft (n = 36) underwent lip repair at a mean age of 5.83 +/- 1.16 months. The hard and soft palates were closed at a mean age of 29.08 +/- 4.68 and 32.25 +/- 4.29 months, respectively. The Brussels children with cleft (n = 26) were treated according to the Malek surgical protocol with soft palate repair at a mean age of 3.04 +/- 0.20 months and simultaneous lip and hard palate repair at a mean age of 6.15 +/- 0.68 months. RESULTS: Statistical analysis (analysis of variance with post hoc Tukey's test) showed a significant (p =.001) smaller mandibular ramus length (Co-Go) in the Brussels cleft group, compared with the control group. The Hannover-Brussels comparison data revealed that the S-N-B angle was significantly (p =.047) less in the Brussels cleft group. CONCLUSIONS: The influence of surgical procedures in patients with UCLP might not be restricted to the maxilla but could influence mandibular spatial position to the cranial base. Because of these positional changes of the mandible, both cleft groups showed facial balance.

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In previous intercenter studies on craniofacial morphology in patients with unilateral cleft lip and palate, probable surgical-induced changes in mandibular morphology and spatial position related to posterior vertical maxillary morphology were identified by our group. These changes could not be detected in other cephalometric cleft studies because posterior vertical maxillary height and vertical mandibular ramus length were not measured simultaneously. This study presents a modified digital lateral cephalometric hard and soft tissue analysis (Onyx Ceph software, version 2.5.6.; Image Instruments GmbH, Chemnitz, Germany) to evaluate craniofacial morphology and growth patterns in patients with clefts. Forty controls without clefts were used to evaluate the accuracy, reliability, and validity of this analysis for future cleft research. Measurement error according to the method of Bland and Altman was less than 1.00 degrees and 1.00 mm, whereas squared correlation coefficients (r) according to the method of Sackett et al showed a high reliability. Method comparison tests according to the method of Bland and Altman clearly showed that the modified digital cephalometric analysis ("test") was valid for future cleft research compared with the "gold standard" (conventional cephalometry).

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Patients with unilateral cleft lip and palate (UCLP) can present with an asymmetric transversal deficiency caused by collapse of the lateral maxillary segment at the cleft side. The surgical technique and orthodontic implications of segmental unilateral transpalatal distraction (TPD) after a posterior maxillary subapical osteotomy using the transpalatal distractor (TPD(R)) are described. The differences between unilateral posterior surgical-assisted rapid palatal expansion (SA-RPE) and segmental unilateral TPD are discussed. The proposed orthodontic-surgical treatment strategy certainly has to be validated by long-term studies in the future.

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OBJECTIVE: This investigation evaluated the results of alveolar bone grafting in patients with complete clefts, comparing secondary alveolar bone grafting (during the mixed stage of dentition) versus tertiary bone grafting (after completion of the second stage of dentition). DESIGN: This was a retrospective study. Of 140 osteoplasties, which all were operated according to the same standardized surgical technique, a clinical and roentgenological follow-up investigation was carried out in a collective of 85 osteoplasties. Clinically we searched for oronasal fistulae, assessed the periodontal status, determined the extent of the gingival attachment in the area of the osteoplasty, and searched for vertical growth disturbances in the area of the osteoplasty. Roentgenologically the height of the alveolar bone in the former clefted area was ascertained. SETTING: Records were obtained from a clinical and radiological study of the Department of Oral and Maxillofacial Surgery of the Medical University of Hannover (Germany). INTERVENTIONS: All patients were operated with the same standardized surgical method. The osteoplastic bridging of the alveolar cleft was performed via a vestibular gingival marginal incision and exclusively by grafting of cancellous bone from the iliac crest. RESULTS: The best results of alveolar bone grafting in cases of secondary osteoplasty were obtained when the lateral incisor or canine had grown into the transplant and had led to a functional stress of the transplanted bone. Approximately good results were to be found in tertiary osteoplasty when the transplanted bone had been stressed functionally through a dental implant. Comparing the secondary with the tertiary osteoplasty, there was a trend of lower resorption in secondary osteoplasty. CONCLUSIONS: Secondary osteoplasty should represent an integral component of any concept for the comprehensive treatment of patients with cleft lip and palate.

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Maxillofacial surgery is a relatively young speciality of medicine and it was not established as an organized specialty until the second half of the 20th century. At first it was supported by general surgeons with particular interest in this field, and also by inspired, extremely talented dentists. During the past few years modern techniques have brought decisive progress also in maxillofacial surgery, leading to rapid further development of diagnostic and therapeutic possibilities. The development of our specialty in the past century is discussed on the four main points of our scope, traumatology, orthognathic, cleft and tumour surgery.Considering the future prospects of our specialty one should realize that in the near future maxillofacial surgery will also be influenced by further medical-technical progress in the field of micro-robots, by percutaneous endoscopic techniques and by minimal invasive or laser surgery.Basic research will also cause a more profound change in our specialty, especially in the field of tumour therapy. Molecular biological research shows some good signs, which could already be transmitted to the prevention, diagnosis and also the therapy of tumours. In the field of tissue transplantation it is no longer utopia that autogenous tissue sampling can be almost completely be avoided. By further developing 'tissue engineering' it will be possible to cultivate bones as well as soft tissue with the aid of gene technology and transplant them into the face using relevant carrier substances. Altogether, the complexity of maxillofacial surgery in the coming century will increase, necessitating the best and widely trained maxillofacial surgeons for successful accomplishment. Copyright 2001 European Association for Cranio-Maxillofacial Surgery.