Worrell, Emma Caroline; (2004) The effects of surgery on facial growth in bilateral cleft lip and palate Sri Lankan subjects. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

A thesis presented on the effects of surgery and the timing of surgery on facial growth and morphology in the bilateral cleft lip and palate Sri Lankan subject. Mixed cross-sectional and longitudinal cephalometric data are used to compare the study cohort with a control Sri Lankan population. The literature on bilateral cleft lip and palate is sparse. Papers solely on bilateral cases are few, with even fewer relating to longitudinal series in this group of patients. This retrospective mixed cross-sectional and longitudinal cephalometric study presents the results of 81 Sri Lankan BCLP subjects and studies the effect of surgery and the timing of that surgery on facial growth. The cohort comprises 58 males, age range 6 - 54 years and 23 females, age range 4 - 55 years. Lateral skull radiographs were taken between 1985 and 2002, each patient having a minimum of 2 and a maximum of 6 radiographs. This thesis examines a range in timing of surgical palatoplasty from infancy to adulthood. Cephalometric analysis explores both intrinsic and iatrogenic features in relation to the study hypotheses. The results support the hypotheses that the unoperated subject displays relatively normal facial growth. Lip repair demonstrated a moulding effect on the dento-alveolar component of the premaxilla but was not responsible for mid-face retrusion. Palatal surgery undertaken at anytime before or during puberty was found to cause deleterious effects to mid-facial growth. Conclusions drawn from this study show no benefit of delaying the hard palate repair from a facial growth perspective. It is suggested that it is the nature of surgical intervention and not the timing of that surgery that is the major factor affecting facial growth outcome.

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