Ko. Henkel et Kkh. Gundlach, ANALYSIS OF PRIMARY GINGIVOPERIOSTEOPLASTY IN ALVEOLAR CLEFT REPAIR .1. FACIAL GROWTH, Journal of cranio-maxillo-facial surgery, 25(5), 1997, pp. 266-269
The primary gingivoperiosteoplasty by Millard consists of presurgical
active orthognathic treatment ('Latham device') of the alveolar margin
s at the age of 3 months and of surgical closure of the alveolar cleft
with local gingivoperiosteal flaps at the age of 5 months. The aim of
this investigation was to analyse the facial growth following this tr
eatment. The following material was studied: lateral head X-rays and p
laster casts from 146 patients with unilateral (UCLP) and bilateral (B
CLP) clefts of lip and palate from birth to 16 years of age. Ninety-on
e of these patients formed the control group, who received neither gin
givoperiosteoplasty nor pre-surgical active orthognathic treatment, Th
e same surgeon and orthodontist treated all 146 patients, A three-dime
nsional growth disturbance after gingivoperiosteoplasty was observed:
42% patients with UCLP and 40% patients with BCLP had an 'open bite' f
ollowing closure of the alveolar cleft (control group 5%/10%). The len
gth of the upper jaw in patients who underwent gingivoperiosteoplasty
was shorter than in the control group, The frequency of posterior cros
s bite was also higher in the gingivoperiosteoplasty group. These resu
lts demonstrate that treatment with a 'Latham device' disturbs facial
growth. Therefore, this treatment should be abandoned.