| Summary: | Indiana University-Purdue University Indianapolis (IUPUI) === The Riley Children's Hospital Craniofacial Anomalies Team rigorously follows a
treatment protocol developed by Dr. Sheldon Rosenstein for the treatment of cleft lip and
palate patients. Rosenstein's protocol incorporates primary bone grafting and alveolar
molding appliances for cleft lip and palate patients. While other cleft lip and palate
treatment centers utilize alveolar molding appliances, there remains debate concerning
the efficacy of primary bone grafting. The principal detraction of primary bone grafting
is the concern that such early surgical treatment affects maxillary and craniofacial growth
and development. The purpose of this retrospective study was to analyze post-treatment
lateral head plates and dental casts of cleft lip and palate circumpubertal patients treated in
infancy at Riley Hospital in Indianapolis by the Craniofacial Team following
Rosenstein's protocol. The hypothesis was that primary alveolar bone grafting in
conjunction with the use of alveolar molding appliances contributes to the early
stabilization of the alveolar segments, and produces no statistically significant difference
in craniofacial development among primary bone grafted patients and nongrafted
patients. The dental arch dimensions of the nongrafted patients (control group) consisted
of the same data utilized by Moorrees in his study of the dentition of the growing child.
The dental arch dimensions of nongrafted cleft patients consisted of the same data
utilized by Athanasiou in his study of the dentition of cleft patients treated surgically
without bone grafting.
Of the eight measurements made by the three examiners, six demonstrated
excellent interexaminer agreement, one demonstrated moderate interexaminer agreement,
and one demonstrated poor interexaminer agreement. The arch width and length for the
grafted group was significantly smaller (p < .05, Student's t-test) than the normal group
in all measures except for the mandibular canine width. The arch width and length for
the grafted group was not significantly different (p < .05, Student's t-test) than the
nongrafted group, except for the maxillary molar width where the grafted group was
smaller than the nongrafted group.
The cephalometric values of the Riley group were compared against a nongrafted
group, an early primary grafted group, and the Bolton standard values cited in
Rosenstein's study. The Bolton standard values were used as the control group.
This study found the cephalometric values of the Riley experimental group
(treated following Rosenstein's protocol) to be of no statistically significant difference
(p < .05, Students t-test) when compared with cephalometric values of the nongrafted and
primary alveolar grafted groups cited in Rosenstein's 1982 study. The cephalometric
values of the Riley experimental group were less than the cephalometric values of the
nonclefted patients (Bolton standard control group) cited in Rosenstein's 1982 study.
Interexaminer agreement ranged from poor to good with the poorest agreement among
the linear values of ANS/PNS and GO/ME. The intraclass correlation coefficient values
for SNA,m ANB, and SNB ranged from fair to moderate.
The Riley cephalometric values were equal or slightly better than Rosenstein's
grafted and nongrafted groups. Though smaller than the control group, the Riley
cephalometric values were of no statistical significance (p < .05, Students t-test) when
compared with the same parameters cited in Rosenstein's study. Although these findings
infer that the patients treated following Rosenstein's protocol demonstrate some degree
of craniofacial growth attenuation when compared with nonclefted patients (Bolton
standard control group), the Riley patients showed no worse growth attenuation than
similar patients treated without Rosenstein's protocol for primary alveolar grafting.
The hypothesis of this thesis was that Rosenstein's protocol was viable and non-detrimental
when compared with other treatment regimens. The results of this study
support the hypothesis that Rosenstein's surgical protocol is not a contributing factor in
craniofacial growth attenuation among cleft lip and palate patients.
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