Dental Arch Relationship Outcomes in One- and Two-Stage Palatoplasty for Japanese Patients With Complete Unilateral Cleft Lip and Palate

Objective: To compare dental arch relationship outcomes following one-and two-stage palatal repair. Design: Nonrandomized, clinical trial with concurrent control. Setting: Hokkaido University Hospital. Patients: Sixty-eight consecutively treated Japanese patients with complete unilateral cleft lip and palate. Interventions: Thirty-one of the 68 patients underwent two-stage palatoplasty with delayed hard palate closure, and 37 patients underwent one-stage pushback palatoplasty. Main Outcome Measures: Dental casts were taken at 4.9 to 6.3 (mean: 5.2) years of age in the two-stage group and at 4.0 to 6.3 (mean: 5.1) years of age in the one-stage group, and dental arch relationships were assessed using the 5-Year-Olds' Index (5-Y) by four raters and the Huddart/Bodenham Index (HB) by two raters. Results: Intrarater and interrater reliabilities evaluated using weighted kappa statistics were good or better for the 5-Y and HB ratings. The mean 5-Y score was 2.94 in the two-stage group and 3.13 in the one-stage group (P value was not significant). However, there was a significant difference in distributions between the groups (P < .05). The HB scores of molars were significantly greater in the two-stage group than in the one-stage group (P < .05). The rank correlation coefficients between the 5-Y and total HB score (rho = -0.840, P < .01) and between the 5-Y and the score of the incisors in the HB (rho = -0.814, P < .01) were significantly increased. Conclusions: These results suggest that the anteroposterior relationship was not significantly different between the groups, but the transversal relationship was better in the two-stage group than in the one-stage group.