Comparison of dental arch relationship and craniofacial characteristics during mixed dentition in patients with complete unilateral cleft lip and palate treated with one-stage versus early two-stage palatoplasty

Objectives: The objective of this study was to evaluate dental arch relationship and craniofacial characteristics in patients with non-syndromic complete unilateral cleft lip and palate (CUCLP) during mixed dentition between the one-stage repair at 12 months and the early two-stage palatoplasty with hard palate repaired at 18 months. Material and Methods: Patients with non-syndromic CUCLP were identified for participation in this retrospective study. All received pre-surgical nasoalveolar molding, and subsequently followed by cheiloplasty at 3–5 months. They were divided into two groups, dependent on the timing of their palate repair. The one-stage group underwent soft and hard palatoplasty at 12 months, while the two-stage group had soft and hard palate repair at 3–5 months and 18 months, respectively. One surgeon exclusively operated on all patients in each group. Pre-orthodontic dental models and cephalograms were collected for the assessment of dental arch relationships and craniofacial morphology during mixed dentition. Great Ormond Street, London and Oslo (GOSLON) scores and cephalometric measurements were compared between the two groups. The reliability of GOSLON ratings and cephalometric measurements was determined with intraclass correlation coefficients. Comparisons of the average GOSLON scores and cephalometric parameters were performed by the Mann–Whitney U-test. The percentage distributions of the GOSLON scores between the two groups were also compared using the Chi-square test. Results: Thirty-two patients with a complete set of pre-orthodontic records were identified. They were of Caucasian or Hispanic origins. The one-stage group consisted of 10 patients (6 males and 4 females). The two-stage group comprised 22 patients (16 males and 6 females). Timings of hard palate repair for the one-stage and two-stage group are 12.9 ± 1.8 months and 18.6 ± 3.1 months, respectively. The age that pre-orthodontic records were taken was not significantly different between the two groups (one-stage = 8.26 ± 0.93 years vs. two-stage = 7.96 ± 0.97 years; P = 0.345). The reliability of GOSLON ratings and cephalometric measurements showed very good agreement. The dental arch relationship was found to be significantly more favorable in the two-stage group (median GOSLON scores = 3 vs. 4, P < 0.05). The GOSLON scores distribution were also significantly different ( P < 0.001) between the two groups. The two-stage group demonstrated a higher proportion of favorable ratings and a lower of unfavorable outcomes. All cephalometric measurements were not significantly different between the two groups. Conclusion: Our findings demonstrated significantly more favorable dental arch relationships in patients who underwent the early two-stage repair. The two-stage group also exhibited a higher proportion of favorable ratings and a lower of unfavorable outcomes. However, all cephalometric measurements were not significantly different between the two groups.