Maxillary Growth at age Five in Complete UCLP Managed with Simultaneous Cheiloplasty and Vomerine Flap, Followed by Intra-Velar Veloplasty

Objective To report the arch relationship in patients with complete unilateral cleft lip and palate operated by the same surgeon, using the same protocol of cheiloplasty combined with vomerine flap to close the anterior palate, followed by palatoplasty with intra-velar veloplasty. Design Retrospective cohort study. Setting Tertiary Cleft Centre. Patients, Participants Consecutive patients born between 2004 and 2015. Interventions Primary and secondary surgery. Main Outcome Measures The primary outcome measure was the Five Year Old (5YO) index score by external specialist orthodontists. The index is a five-point scale and considers Groups 1 and 2 as demonstrating ‘good’ maxillary growth; Group 3 as ‘fair’ and Groups 4 and 5 as ‘poor’. Results Ninety-six patients met the inclusion criteria and 81 (84%) were successfully reviewed. The results were: Group 1, 9 patients (11.1%); Group 2, 38 (46.9%); Group 3, 23 (28.4%); Group 4, 10 (12.3%); and Group 5, 1 (1.2%). Hence 58% had good growth, 29.4% fair and 13.5% poor. The median age at review was 5.2 years (5.0–6.3). Patients with a soft tissue band had marginally better growth scores but this was not significant ( p = . 19). At palatoplasty 47.5% did not require lateral releasing incisions. Conclusions The protocol used has favourable maxillary growth outcomes at age five and compares well with other published data. The vomerine flap possibly reduces the cleft width which could explain why only just over half the patients needed lateral releasing incisions at palatoplasty.