Treatment of bilateral cleft lip and palate: long term results and future perspectives

In the Netherlands about 1 in 500 children are born with a cleft of lip and/or a cleft palate. In most cases the cleft is unilateral (UCLP), however 1 in 5000 children are born with a bilateral cleft cleft lip and palate (BCLP). Patients with BCLP are preferably treated in a tertiary center, such as the Wilhelmina Children’s Hospital of the University Medical Center Utrecht. This thesis is a thorough analysis of the surgical closure of the BCLP using secondary alveolar bongrafting (SABG) in combination with a premaxillary osteotomy of 60 children over a period of 10 years. It contains a literature review as well as an analysis on growth, surgical outcome and its complications. The over-all end result of the treatment protocol at 18-years of age was analyzed using a newly developed dento-maxillary scoring system with a scale form 1 to 10.
A correlation was found between the occurrence of complications and 1. the timing of the SABG procedure and 2. the presurgical preparations. We observed the best results in patients operated between eight and twelve years. Growth inhibition of the midface after surgery was of limited relevance in this patient group. However if the ANB-angle was preoperatively already below six degrees, there was a 78% probability that a maxillary advancement osteotomy was needed to achieve a normal incisor relationship at the age of 18 years.
Considering the over-all end result at 18 years for this patient group, the study found a dento-maxillary score of 7.6.
Finally the future of bone grafting was investigated. A literature review was done to explore the possible use of a fabricated bone transplant with multipotent stem cells, to replace the gold standard of the autologous bone graft.