Effect of Infant Orthopedics on Facial Appearance of Toddlers With Complete Unilateral Cleft Lip and Palate (Dutchcleft)

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doi: 10.1597/07-043.1
The Cleft Palate-Craniofacial Journal: Vol. 45, No. 4, pp. 407–413.

Effect of Infant Orthopedics on Facial Appearance of Toddlers With Complete Unilateral Cleft Lip and Palate (Dutchcleft)

Catharina A.M. Bongaarts, D.D.S., Birte Prahl-Andersen, D.D.S., Ph.D., Ewald M. Bronkhorst, Ph.D., Paul H.M. Spauwen, M.D., Ph.D., Jan W. Mulder, M.D., Ph.D., J. Michiel Vaandrager, M.D., and Anne M. Kuijpers-Jagtman, D.D.S., Ph.D.
Dr. Bongaarts is orthodontist at the Department of Orthodontics and Oral Biology, Radboud University Nijmegen Medical Center, the Netherlands. Dr. Prahl-Andersen is Emeritus Professor in Orthodontics, Academic Center of Dentistry Amsterdam, and Former Head of the Department of Orthodontics, Erasmus MC University Medical Center Rotterdam, the Netherlands. Dr. Bronkhorst is biostatistician at the Department of Preventive and Curative Dentistry, Radboud University Nijmegen Medical Center, the Netherlands. Dr. Spauwen is Professor and chairperson of the department of Plastic and Reconstructive Surgery at the Radboud University Nijmegen Medical Center, the Netherlands. Dr. Mulder is Emeritus Professor in the Department of Plastic Surgery, VU University Medical Center, Amsterdam, the Netherlands and member of the cleft lip and palate team of the Academic Center of Dentistry in Amsterdam, the Netherlands. Dr. Vaandrager was Plastic Surgeon and Former head of the Craniofacial Center, Department of Plastic and Reconstructive Surgery, Erasmus MC University Medical Center Rotterdam, and member of the cleft lip and palate team of Erasmus MC University Medical Center Rotterdam in Rotterdam, the Netherlands. Dr. Kuijpers-Jagtman is Professor and Chairperson of the Department of Orthodontics and Oral Biology, and Head of the Cleft Palate Craniofacial Unit of the Radboud University Nijmegen Medical Center, the Netherlands.

Anne M. Kuijpers-Jagtman, D.D.S., Ph.D.
The research is part of the Dutch intercenter study into the effects of infant orthopedic treatment in complete UCLP (Dutchcleft), carried out in a collaboration between the Cleft Palate Centers of the Radboud University Nijmegen, Academic Center of Dentistry in Amsterdam, and Erasmus MC University Medical Center in Rotterdam (coordinating orthodontists A.M. Kuijpers-Jagtman and B. Prahl-Andersen)

Objective: To evaluate the effect of infant orthopedics (IO) on facial appearance of 54 patients with unilateral cleft lip and palate (UCLP), aged 4 and 6 years.
Design: Prospective two-arm randomized controlled clinical trial in three Cleft Palate Centers in the Netherlands (Dutchcleft-trial).
Interventions: Patients were divided randomly into two groups. Half of the patients (IO+) had a plate until surgical closure of the soft palate at the age of ± 52 weeks; the other half (IO−) received no intervention.
Main Outcome Measures: Facial appearance at 4 and 6 years of age assessed on full face photographs and photographs showing only nose and mouth. Ratings were performed on a VAS-scale by professionals and laymen.
Results: At 4 years of age the full face pictures of IO+ children were scored to be more attractive than those of IO− children. However, this difference had disappeared at 6 years of age. At the age of 6, only professionals saw a significant difference on nasolabial photographs between IO+ and IO−. Regression analysis showed a minor effect of occlusion, lip revision, or type of nose reconstruction on the esthetic results.
Conclusions: IO had a positive effect on full facial appearance of UCLP children at the age of 4 years, but at the age of 6, only professionals saw a positive effect of IO on the nasolabial photographs. This is irrelevant for UCLP patients since they deal with laymen in their daily life.

KEY WORDS: esthetics, cleft palate, treatment outcome, infant orthopedics, randomized clinical trial, multicenter

Submitted March 2007; Accepted December 2007.