Effects of two flap palatoplasty versus furlow palatoplasty with buccal myomucosal flap on maxillary arch dimensions in patients with cleft palate at the primary dentition stage: a cohort study

Abstract

Objective: The objective of this study was to evaluate the effect of two flap palatoplasty (TFP) versus Furlow palatoplasty with buccal myomucosal flap (FPBF) on maxillary arch dimensions in children at the primary dentition stage with cleft palate, in comparison to matching subjects without any craniofacial anomalies.

Material and methods: This study included 28 subjects with an age range of 5-6 years; 10 non-cleft subjects were included in the control group, 9 patients treated with TFP, and 9 patients treated with FPBF. For the included patients, the maxillary models were scanned using a desktop scanner to produce virtual models, and the maxillary dimension measurements were virtually completed. The produced measurements were compared between the 3 groups. Maxillary models of the 28 participants were evaluated.

Results: Statistically insignificant differences were detected between the 3 groups for arch symmetry measurements. Differences were detected in the inter-canine width between the 2 surgical groups and non-cleft group. Both arch length and posterior palatal depth significantly differ while comparing the TFP to the control group, with no differences between FPBF and the non-cleft group.

Conclusion: Furlow palatoplasty with buccal myomucosal flap might be considered a better surgical option than two flap palatoplasty for patients with cleft palate while evaluating maxillary arch dimensions at the primary dentition stage as a surgical outcome.

Clinical relevance: This study gives insight into the surgical technique that has limited effect on the maxillary growth and dental arch dimension. Therefore, it decreases the need for orthodontic treatment and orthognathic surgery.

Trial registration: clinicaltrials.gov ( NCT05405738 ).

Keywords: Cleft palate; Furlow with buccal myomucosal flap palatoplasty; Maxillary dental arch; Two flap palatoplasty.

Fig. 1

Two flap palatoplasty surgical technique. a Showed reflection of the oral mucosa and nasal mucosal layer closure in two flap palatoplasty surgical technique; b Showed immediate postoperative view of the operated cleft by two flap palatoplasty technique

Fig. 2

Furlow palatoplasty with buccal myomucosal flap surgical technique. a Showed preoperative view with Furlow palatoplasty incision outline (Z-plasty on the oral side and the nasal mucosa); b nasal mucosal layer closure; c showed the buccal flap incision; d showed the immediate postoperative view after buccal flap rotation and closure of the palate residual gap between the soft and hard palate on the oral mucosal side

Fig. 3

a Model’s measurements; 1- Inter-canine width (mm), 2- Intermolar width (mm), 3- Arch Length (mm), b Model’s measurments;4- Anterior Palatal Depth (mm), 5-Posterior Palatal Depth (mm), c Model’s measurments; 6- Right Side Angle (degrees), 7- Left Side Angle (degrees), d Model’s measurements; 8- Right Canine Distance to midline (mm), 9- Left Canine Distance to midline (mm), 10- Right Molar Distance to midline (mm), 11- Left Molar Distance to midline (mm)