J. Jpn. Cleft Palate Assoc. 24: 281-291, 1999 Interrelations between Craniofacial Dysmorphology and Collapsed Upper Dental Arch in Unilateral Cleft Lip and Palate Patients. Atsushi NUNOTA, Nobuyoshi MOTOHASHI and Takayuki KURODA Abstract : The purpose of this study was to clarify interrelations between craniofacial dysmorphology and collapsed upper dental arch in unilateral cleft lip and palate. Material and Method : Lateral and frontal cephalegrams and gnathostatic models of 27 male unilateral cleft lip and palate patients taken at the first examination (mean age : 9 years 0 Maxillofacial Orthognathics, Graduate School, Tokyo Medical and Dental University
months) were used for this study. In the cephalometric analysis, 25 measurements were measured in the saggital and frontal dimension. In the gnathostatic model analysis, 9 measurements representing maxillary collapsed dental arch (@ whole dental arch collapse, 0 arch width collapse, and 0 arch length collapse) were measured on the three-dimensional dental model graphics generated by the noncontact three-dimensional dental model analyzer ( UNISN VMS25OR ). Firstly, cephalometric measurements to represent the characteristic craniofacial dysmorphology were distilled by comparison with the normative non-cleft data. Secondly, the correlation between these cephalometric measurements and model measurements were evaluated at the significant levels of 5 % and 1 % respectively. The significant pairs were examined according to each aspect of upper collapsed dental arch. Results : 1. Comparative cephalometric analysis revealed characteristic craniofacial dysmorphology Midfacial growth retardation, lingual tipping of upper central incisor, low mandibular plane and increased mandibular length in the saggital dimension ; 0 Increased interorbital distance, narrowed nasal width, mandiblar midline deviation and midpoint deviation of the upper and the lower central incisors from the facial midline in the frontal dimension. 2. In the saggital dimension, the whole dental arch collapse showed significant correlations with retruded maxilla and decreased midfacial depth. The decreased upper arch width showed significant correlations with decreased anterior basal height and increased mandibular length. The decreased upper arch length showed significant correlations with decreased midfacial depth, lingual tipping of upper central incisor, increased mandibular length and low mandibular plane. In the frontal dimension, the whole dental arch collapse showed significant correlations with mandibular midline deviation from the facial midline, and the decreased upper arch width showed significant correlations with mandibular midline deviation from the facial midline as well as narrowed nasal width. However, the collapsed upper dental arch showed no significant correlations with increased interorbital distance and midpoint deviation of the upper and the lower central incisors from the facial midline. The results suggested that the collapsed palatal vault after surgical repair of cleft lip and palate influenced the following growth of the craniofacial structure resulting in characteristic distorted facial harmony. Key words : Unilateral cleft lip and palate, upper dental arch collapse, craniofacial dysmorphology, cephalometric analysis, dental model analysis
日 口蓋看志24巻1999285 Fig.3Dentalmodelmeasurements ①(a)palatalvolume②(a)upPerintramolarwidth③(a)upPerarchlength ①(b)palatalarea②(b)ratioofupPerto③(b)ratioofupPerto ①(c)upPerarcharealowerintramolarwidthlowerarchlength ①(d)ratioofupPerto②(c)upPerintramolar lowerarchareasectionalarea Fig.5Meanskeltalpatternofthecleft subjectsinthefrontaldimension 蓋 裂 患 者 は,眼 (-1.3 Fig.4Meanskeltalpatternofthθcleftsub- S.D.),上 窩 間 幅 径(+1.5 部 最 下 点 偏 位 量(+9.3S.D.)に 下 縁 平 面 傾 斜 角(-1.2 長(+1.5S.D.)が S.D.)が 小 さ く,下 顎骨 大 き く偏 位 した 値 を示 し た 前 頭 面 形 態 に お け る 特 徴 と して,片 側性 口唇 口 腔幅径 顎 中 切 歯 偏 位 量(+7.2S D.), 下 顎 中 切 歯 偏 位 量(+4.OS.D.)お jectsinthelateraldimension S.D.),鼻 よ び オ トガ イ 大 き な 偏 位 をみ た 2.特 徴 的 顎 態 パ タ ン と上 歯 列 弓狭 窄 との 関 連 (1)顎 顔 面 側 面 形 態 と上 歯 列 弓 形 態 との 関 連 Table.1に 側 面 頭 部X線 規 格 写 真 分 析 よ り抽
1) Motohashi, N. Kuroda, T., Filho, L. C., et al. : P-A cephalometric analysis of nonoperated adult cleft lip and palate. Cleft Palate Craniofac. J. 31 : 193-200, 1994. 2) Moriyama, K., Motohashi, N., Kitamura, A., et al. : Comparison of craniofacial and
dentoalveolar morphologies of three Japanease monozygotic twin pairs with cleft lip and / or palate discordancy. Cleft Palate Craniofac. J. 35(2) : 173-180, 1998. 47: 757-766, 1988. 5) Purzansky, S. and Aduss, H.: Prevalence of arch collapse and malocclusion in complete unilateral cleft lip and palate. Trans. Europ. Orthodont. Soc., 43 : 365-382, 1967. approach to clinical management and reha- bilitation of the patients, ed. Cooper, H. K., et al., Phiadelphia London Toronto, 1979, W. B. Saunders Co., 359-429. 28) Graber, T. M. : The congenital cleft palate 1997. 17) Graber, T. M.: A cephalometric analysis of the developmental pattern and facial morphology in cleft palate, Amer. J. Orthodont, 19 : 91-100, 1949. 72 : 1269-1318, 1972. 24) Ross, R. B. : The clinical implication of facial growth in cleft lip and palate. Cleft Palate J., 7 : 37-46, 1970. 27) Cooper, H. K., Long, R. E., Long, R. E. Jr., et al. : Orthodontics and Oral orthopedics, in Cleft palate and cleft lip ; A team deformity, J. Amer. Dent. Ass. 48 : 375-395, 1964. 29) Levin, H. S. : A cephalometric analysis of cleft palate deficiencies in the middle third of the face, Angle Orthodont. 33 : 186-194, 1963. 1-28, 1981. 35) Ross, R. B., Johnston, M. C. : The effect of early orthodontic treatment on facial growth in cleft lip and palate. Cleft Palate J., 4 : 157-164, 1967. 36) Hotz, M. and Gnoinski, W.: Comprehensive care of cleft lip and palate children at
Zurich University : A preliminary report. Amer. J. Orthodont., 70 : 481-540, 1976.