Table 2 presents the cephalometric parameters in the vertical dimension in CP patients with and without ONF. The results of the t-test revealed that the Y-axis was significantly greater in CP patients with ONF compared with those without ONF (P<0.05). Also, the mean size of gonial angle was significantly larger in CP patients with ONF compared with those without it (P<0.05). Go1 and Go2 in CP patients with ONF were significantly greater than the corresponding values in patients without a fistula (P<0.05). The Go-GN-SN parameter was significantly greater in CP patients with ONF as well (P<0.05). The Jarabak index was significantly lower in CP patients with ONF compared with those without it (P<0.05).
Cephalometric parameters
Absence of ONF
Presenceof ONF
P value (t-test)
Y-axis
66.4±5.8
71.5±3.6
0.001
Gonial angle
125.3±6.9
131.9±6.4
0.003
Go1
53.2±6.3
55.55±4.8
0.04
Go2
72.15±4.9
76.85±6.2
0.012
Go-GN-SN
33.4±4.1
35.9±3.5
0.038
N-Me
113±12.6
118.7±9.6
0.116
S-Go
67.95±7.3
71.15±9.1
0.228
Jarabak Index
63.15±6.2
59.5±4.2
0.035
Inclination Angle
84.25±5
83.25±7.7
0.629
Table 3 presents the dental cephalometric parameters in CP patients with and without ONF. The U1-SN in CP patients with ONF was significantly higher than that in the group without fistula (P<0.005).
Cephalometric parameters
Absence of ONF
Presenceof ONF
P value (t-test)
U1-Sn
99±14.3
74.2±17.5
0.001
U1-NA
5.05±2.6
5.80± 2.8
0.445
L1-Mand
90.85±8
89.4±8.7
0.289
L1-NB
4.05±1.8
4.00±1.8
0.947
InterincisalAngle
128.05±26.5
111.63±58.2
0.962
Table 4 presents the soft tissue cephalometric parameters in CP patients with and without ONF. Among the soft tissue cephalometric parameters, the lower lip to E-line was significantly larger in CP patients with fistula (P<0.005).
Cephalometric parameters
Absence of ONF
Presenceof ONF
P value (t-test)
Nasolabial Angle
100.45±18.3
96.2±16.6
0.446
Up-lip to E-line
-3.25±3.4
-3.5±4.7
0.678
Low-lip to E-line
-1.25±2.6
1.6±4.2
0.015
Naqvi et al. [13] reported short maxillary height in unoperated patients with ONF. However, the patients had a vertical growth pattern in their study. Their results were in agreement with our findings. With regards to the anterior growth however the results were in contrast to ours, which may be due to the presence of a healthy control group in their study. Moreover, our study evaluated patients with and without ONF who had undergone corrective surgery. Patients with CP have a lower anteroposterior growth than healthy individuals [14,15]. Xu et al, [8] in their case-control study on 106 cephalograms of non-syndromic CP patients and 102 healthy controls in three groups of samples reported shortened cranial base length and reduced bony nasopharyngeal height in patients with unrepaired isolated CP. The patients also had short maxillary depth and height, and a posteriorly positioned maxilla. The width of the nasal cavity, maxilla and orbit had increased and they had shortened mandibular length and height. Adults had normal nasopharyngeal and mandibular morphology. Nonetheless, they still had shortened cranial base length and short maxillary depth and anterior height. The width of the nasal cavity, maxilla and orbit had increased in them. They concluded that the craniofacial growth and morphology in unrepaired isolated CP patients is significantly affected by non-surgical factors. The same results were reported by Ye et al [8]. The difference between our results and theirs is due to the presence of a healthy control group in the aforementioned studies and the fact that we evaluated patients who had undergone corrective surgery while they studied unoperated patients.In contrast to our study Costello et al. [16] reported that the maxillary growth was much lower in unoperated patients while the posterior facial height was higher in operated patients. Liao and Mars [14] evaluated 39 patients with CP over 17 years of age in comparison with age- and gender-matched controls. They reported that patients with unilateral cleft lip and palate (CLP) had shorter height of the basal maxilla, shorter posterior length of the basal maxilla, and less protruded basal maxilla at the zygomatic level, compared with the control group. They found a significant correlation between the posterior height of the basal maxilla and size of the cleft maxillary segment [14]. The difference between their results and ours may be due to the fact that they only evaluated the maxilla while we assessed the cranial growth pattern. Capelozza et al. [17] evaluated the craniofacial morphology in CLP patients using lateral cephalometry. They reported that CLP patients had a smaller and more protruded maxilla. Also, the anteroposterior facial height was much larger in CLP patients, and significant differences were noted between CLP patients and healthy controls in the mandible (body, ramus, gonial angle, and mandibular plane angle). The difference between their findings and ours in the anteroposterior dimension may be due to the fact that they had a healthy control group. Racial differences and number of lost teeth can also affect the results. Yoshida et al. [18] evaluated the morphology of unoperated CLP patients using lateral cephalometry. They reported maxillary retrusion and a steeper mandible in CLP patients, and the tendency for maxillary retrusion and a steeper mandible had a direct correlation with age. They also reported the absence of labial proclination of incisor teeth in CLP patients. However, 3 patients with CP had labial proclination of the incisor teeth. Controversy in the results can be due to the difference in age range of the patients, the presence of a healthy control group and the fact that they evaluated unoperated patients. The sample size, age range of patients, technique of surgery, and racial and environmental characteristics may explain the controversy in the results of studies. Tooth loss and its time can also affect the results.In general, the ONF presence is associated with a vertical growth pattern When diagnosing and treating CP patients with ONF, orthodontists should recognize the facial growth pattern in order to reduce undesirable instances of craniofacial development to the extent possible.This study was somewhat limited by its sample size. In order to examine the efficacy of different corrective surgical techniques and their timing on the cranial growth pattern of CP patients more conclusively, similar procedures with larger group of participants are recommended. 5. CONCLUSIONCP patients with ONF experienced a significantly greater growth in the vertical dimension compared with those without ONF. However, no significant difference was noted in the anteroposterior dimension between the two groups.AUTHOR CONTRIBUTIONSAJ: study concept, data interpretation, writing and revising the report and final approval of the article. LN: study design, literature review. MN: administration, data interpretation, recruitment, statistical analysis. MAF: data gathering, data interpretation. MOF: critical revision and final approval of the article. ZK: statistical analysis and critical revision. AD: drafting, data interpretation, critical revision and final approval of the article.CONFLICT OF INTEREST4. DISCUSSIONThis study aimed to assess the cephalometric parameters prior to orthodontic treatment of 6-10-year-old CP patients who had undergone corrective surgery at 1 year of age in two groups with and without ONF. The results showed that in the anteroposterior dimension, no significant difference existed between the two groups. However, in the vertical dimension, patients with ONF had significantly greater vertical growth. This stark difference in the vertical dimension may be due to mouth breathing in children, causing a more vertical growth pattern in patients with ONF.There is no conflict of interest. Table 2. Cephalometric parameters in the vertical dimension in CP patients with and without ONF.. Figure 4. Occlusal view without oronasal fistula. Table 3. Dental cephalometric parameters in CP patients with and without ONF. Table 1. Cephalometric parameters in the anteroposterior dimension in CP patients with and without ONF. Table 3. Soft tissue cephalometric parameters in CP patients with and without ONF.247-252Jamilian A, et al.Original Articles REFERENCES247-252Cephalometric parameters in cleft palate patientsOriginal Articles Abdolreza JAMILIANDDS, PhD, Professor Department of OrthodonticsFaculty of DentistryCranio Maxillofacial Research CenterIslamic Azad UniversityTehran, IranCVProfessor Abdolreza Jamilian is a researcher and specialist in the field of Orthodontics. He received his D.D.S (1991), MSc in Orthodontics (1998), and Fellowship of Orthognathic Surgery & Craniofacial Syndromes (2010) from the Shahid Beheshti University in Tehran, Iran. He obtained his membership of the European Board of Orthodontics in 2013. Now he is professor at the Islamic Azad University in Tehran. His practice is limited to orthodontics. He has lectured in several international congresses and has been a consultant for various journals. He has published over 200 original, peer reviewed research and review articles, 15 book chapters and more than 300 scientific communications. He holds 3 patents in the United States Patent and Trademark Office. Research interests: Class 3 malocclusion, Cleft lip and palate, Orthognathic surgery. 247-252Jamilian A, et al.Questions 1. What are the main symptoms associated with ONF?qa. Hypernasality;qb. Less growth in the vertical dimension;qc. Maxillary protrusion;qd. Mandibular retrusion.2. According to this article, what is the difference between the growth patterns of patients with fistula and patients without fistula? qa. Greater growth in the anteroposterior dimension between the two groups;qb. Less growth in the maxilla in patients with fistula compared with those without ONF;qc. Greater growth in the vertical dimension in patient with fistula compared with those without ONF;qd. No significant difference was noted between the two groups.3. According to this article, at what age did patients with cleft palate perform surgery?qa. At 6 years of age;qb. At 10 years of age;qc. Between 6 to 10 years of age;qd. At 1 year of age.4. According to this article, what causes a recurrence of a fistula after surgery? qa. Genetic factors;qb. Patient age at surgery;qc. Patient gender;qd. Penetration.Original Articles
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