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Intrinsic and Extrinsic Dental Predictors for Maxillary Hypoplasia and Le Fort I Advancement in Cleft Patients
Han Hoang, MD, PhD, Rachel Mandelbaum, BA, Thomas Willson, MD, Raquel Ulma, MD, DDS, R. Christian Solem, DDS, Martin G. Martz, MS, DDS, James P. Bradley, MD, Libby Wilson, MD, Justine C. Lee, MD, PhD.
University of California Los Angeles, Los Angeles, CA, USA.

PURPOSE:
Severe maxillary hypoplasia in cleft patients is caused by a combination of pathogenic and iatrogenic factors. In this work, we evaluated the anatomic deficiencies and manipulation of dentition for predicting Le Fort I maxillary advancement surgery for severe maxillary hypoplasia in cleft patients.
METHODS:
Cleft lip/palate and cleft palate patients older than 15 years of age at two institutions (UCLA and the Los Angeles Orthopaedic Hospital) were retrospectively reviewed. Chi square tests, t tests, and multivariate logistic regression analyses were performed to delineate the contribution of quantity and position of dental agenesis to maxillary advancement surgery.
RESULTS:
In the 214 patients reviewed (mean age 19.7 years), 61.5% had dental agenesis, and 49.6% required Le Fort I advancement. In patients without dental agenesis, 22.4% required Le Fort I advancement versus 70.1% of patients with dental agenesis (p<0.0001). When dental agenesis was treated with canine substitution, Le Fort I advancement increased to 81.1% (p<0.0001). Both SNA (p=0.02) and ANB (p=0.004) measurements were decreased in patients missing dentition. Multivariate logistic regression analyses demonstrated that both dental agenesis and orthodontic canine substitution are independent predictors for Le Fort I advancement surgery (OR 3.5, CI 1.55-7.90, p=0.003; OR 3.5, CI 1.56-7.68, p=0.002).
CONCLUSION:
Dental contributions to maxillary hypoplasia in cleft children stem from intrinsic and extrinsic factors. Dental agenesis, as an anatomic readout of intrinsic growth deficiency, and canine substitution, as an extrinsic maneuver to correct cleft spaces, were both strongly associated to maxillary hypoplasia predicted subsequent Le Fort I advancement


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