chapter 1 [contents]

Chapter 1 gives a short introduction to the topic of the thesis. The

history of infant orthopedics is explained and its shortcomings and

benefits. Because there are so many drawbacks of previous studies, no

evidence based information was available. This was the reason to start

Dutchcleft, a prospective randomized clinical trial in three cleft palate

centers (Nijmegen, Amsterdam, and Rotterdam). The study started in

1993 and comprised 4 main subjects: (1) general aspects, (2) surgical and

orthodontic aspects, (3) speech and language development, (4) cost -

effectiveness. A child entered the study within two weeks after birth, and

was randomly assigned to the IO+ (treatment with infant orthopedics) or

IO- group (treatment without infant orthopedics). A total of 54 children

from three cleft palate centers was included; 27 in each group. In two

earlier thesis the short term results of the trial were presented. In the

present thesis the midterm results for the orthodontic and surgical

variables are presented.

chapter 2 [contents]

In chapter 2 the effect of infant orthopedics (IO) on the occlusion of

the deciduous dentition is described. Dental arch relationships were

assessed at 4 and 6 years of age with the 5-year-old index, the Huddartscore,

and with measurements of overjet, overbite, and sagittal occlusion.

There were no significant differences found between the IO+ and IOgroups

for the 5-year-old index, the Huddart-score, and for overjet,

overbite, and sagittal occlusion.

chapter 3 [contents]

Chapter 3 describes a study into the effect of IO on maxillary arch

dimensions in the deciduous dentition. The maxillary arch dimensions

were assessed on dental casts at 4 and 6 years of age with measurements

for arch width, arch depth, arch length, arch form, and the vertical

position of the lesser segment. Contact and collapse were also assessed.

IO had no observable effect on the maxillary arch dimensions or on the

contact and collapse scores in the deciduous dentition at the age of 4 and

6 years.

chapter 4 [contents]

Facial appearance at 4 and 6 years of age was assessed and the

results are described in chapter 4. Full face photographs and photographs

showing only nose and mouth were scored. Ratings were performed on a

VAS-scale by professionals and laymen. At 4 years of age the full face

pictures of IO+ children were scored to be more attractive than full face

pictures of IO- children. However, this difference had faded away at 6

years of age. At the age of 6, only professionals saw a significant

difference on nasolabial photographs between IO+ and IO-. Regression

analysis showed a minor effect of occlusion, lip revision, or type of nose

reconstruction on the esthetic results. IO had a positive effect on full

facial appearance of UCLP children at the age of 4 years, but at the age

of 6, only professionals saw a positive effect of IO on the nasolabial

photographs. This is for UCLP patients irrelevant since they deal with

laymen in their daily life.

chapter 5 [contents]

In chapter 5 the reliability of some cephalometric measurements in

unilateral cleft lip and palate patients was tested. Measurements with A,

ANS, and PNS, were compared to measurements performed with

alternatives for these points: A1, A2, ANS1, ANS2, and PNS1.

Cephalograms of children with complete UCLP (n=164), with a lateral

head film taken at age 4 to 6 were used. Intra- and interobserver

reliability for cephalometric measurements including A, ANS, PNS or

their alternatives were calculated: Dahlberg errors, systematic errors and

Pearson correlation coefficients. The measurements using ANS and PNS

or their alternatives, were comparable. The systematic error between

observers for measurements using A2 was less than for measurements

using A or A1. The scatter plot of point A showed a slightly better

distribution of the points than the plots of A1 and A2. Although the

landmarks A, ANS and PNS are hard to trace in UCLP patients with tooth

germs in the anterior maxilla, no better landmarks were found, but

cephalometric studies using A, ANS and PNS in UCLP patients should be

chapter 6 [contents]

In chapter 6 the effect of IO on facial growth of UCLP patients,

aged 4 and 6 years was evaluated. Measurements were done on lateral

headfilms made at 4 and 6 years of age to get cephalometric values

representing soft tissue, hard tissue and dental structures. No differences

were found between IO+ and IO-, except for two measurements; the

interincisal angle was larger (4 years of age) and the mentolabial angle

was smaller (6 years of age) in the IO+ group. It was concluded that

facial growth measurements at age 4 and 6 gave no reason to perform IO

chapter 7 [contents]

Finally, in chapter 7, the general discussion, some methodological

issues regarding the results are discussed. It describes the strength and

weaknesses of the studies done, and gives implications for treatment. The