Pre-maxillary complex morphology in bilateral cleft and hypothesis on laterality of deviated pre-maxilla

ABSTRACT

Introduction: Pre-maxillary complex (pre-maxilla [PMX] + vomer) morphology in bilateral complete cleft of primary and secondary palate (BCLCP) is very complex and less reviewed in literature. Materials and Methods: In this retrospective cross-sectional study, 200 consecutive BCLCP patients were selected. Their pre-operative clinical photographs and dental casts were evaluated by a single investigator at two different points of time, to study the morphology of PMX and vomer with special emphasis on deviation of vomer and rotation of PMX. Results: It is found that in above 70% of patients, PMX and vomer both displaced or deviated towards left side in horizontal plane and PMX rotated anticlockwise at PMX vomerine suture (PVS). In 10% of cases, both PMX and vomer are displaced towards the right side, PMX rotated clockwise at PVS. In 11% of cases, vomer is displaced towards the left side, but PMX rotated clockwise at PVS. In 5% of cases, vomer is displaced towards the right side, but PMX rotated anticlockwise at PVS. Both PMX and vomer are in midline in 4% of cases. Conclusion: Specific morphological deviation of vomer and PMX has been studied. We put forward the probable hypothesis to explain the deviation and rotation of PMX.

KEY WORDS

Anticlockwise - bilateral complete cleft of primary and secondary palate - clockwise - cross-sectional - pre-maxilla - pre-maxillary-vomerine complex - pre-maxillary-vomerine suture - retrospective

• REFERENCES

• 1 Barteczko K, Jacob M. A re-evaluation of the premaxillary bone in humans. Anat Embryol (Berl) 2004; 207: 417-37
• 2 Shepherd WM, McCarthy MD. Observations on the appearance and ossification of the premaxilla and maxilla in the human embryo. Anat Rec 1955; 121: 13-28
• 3 Carstens MH. Developmental field reassignment in unilateral cleft lip: Reconstruction of the premaxilla. Indian J Plast Surg 2007; 40: 75-101
• 4 Carstens MH. Neural tube programming and the pathogenesis of craniofacial clefts, part I: The neuromeric organization of the head and neck. In: Samat HB, Luratolo P. editors Handbook of Clinical Neurology, Malformations of the Nervous System. Vol. 87. 3rd Series Esevier B.V.; 2008: p. 247-67
• 5 Latham RA. Maxillary development and growth: The septo-premaxillary ligament. J Anat 1970; 107 Pt (03) 471-8
• 6 Malek R. The nature and lesions of bone lesions. Cleft Lip and Palate Lesions, Pathophysiology and Primary Treatment. London: Martin Duniz Ltd.; 2001
• 7 Talmant JC. Evolution of the functional repair concept for the cleft lip and palate patients. Indian J Plast Surg 2006; 39: 196-209
• 8 Pruzansky S. The growth of the premaxillary-vomerine complex in complete bilateral cleft lip and palate. Tandlaegebladet 1971; 75: 1157-69
• 9 Friede H, Johanson B. A follow-up study of cleft children treated with primary bone grafting 1. Orthodontic aspects. Scand J Plast Reconstr Surg 1974; 8: 88-103
• 10 Latham RA. Development and structure of the premaxillary deformity in bilateral cleft lip and palate. Br J Plast Surg 1973; 26: 1-11
• 11 Vargervik K. Growth characteristics of the premaxilla and orthodontic treatment principles in bilateral cleft lip and palate. Cleft Palate J 1983; 20: 289-302
• 12 Handelman CS, Pruzansky S. Occlusion and dental profile with complete bilateral cleft lip and palate. Angle Orthod 1968; 38: 185-98
• 13 Berkowitz S. Complete bilateral cleft lip and palate. Cleft Lip and Palate – Diagnosis and Management. 2nd ed.. Vol. 34, Ch. 6 San Diego, London: Singular Publishers; 2006: p. 99-191
• 14 Piontelli A. Development of normal fetal movements: The first 25 weeks of gestation. Fetal breathing movements. Milan, Italy: Springer; 2010: p. 39-47
• 15 Rama S. Path of Fire and Light: Advanced Practices of Yoga. Vol. 1. Delhi: Himalayan Institute Press; 1986
• 16 Hepper PG. The developmental origins of laterality: Fetal handedness. Dev Psychobiol 2013; 55: 588-95
• 17 Hepper PG, Shahidullah S, White R. Handedness in the human fetus. Neuropsychologia 1991; 29: 1107-11
• 18 Reissland N, Francis B, Aydin E, Mason J, Exley K. Development of prenatal lateralization: Evidence from fetal mouth movements. Physiol Behav 2014; 131: 160-3
• 19 Reiss M, Reiss G. Current aspects of handedness. Wien Klin Wochenschr 1999; 111: 1009-18