Long-Term Craniofacial Growth Outcomes in Children with Repaired Cleft Lip and Palate in South East Nigeria: A Longitudinal Cephalometric Investigation

The long-term impact of primary cleft lip and palate repair on craniofacial growth trajectories remains a subject of debate in the reconstructive surgical literature. Surgical intervention during critical periods of craniofacial development may alter maxillary growth, nasal cartilage development, and dental arch dimensions, but the magnitude and directionality of these effects in Nigerian children repaired at public cleft centers have not been longitudinally investigated. This PhD study conducts a longitudinal cephalometric investigation of craniofacial growth outcomes in children with repaired unilateral cleft lip and palate (UCLP) followed from initial cleft repair through late adolescence at the National Orthopaedic Hospital Enugu and UNTH Enugu, South East Nigeria. Sixty-two UCLP patients repaired before 24 months of age were compared with 62 non-cleft age- and sex-matched controls. Lateral cephalometric radiographs were obtained at ages 5, 9, 13, and 17 years and analyzed by a calibrated orthodontist using standardized skeletal and dental landmark measurements. Mixed-effects longitudinal models assessed growth trajectory differences between groups over time. Results demonstrate significantly reduced maxillary length and retroposition of the A-point in the UCLP group compared to controls from age 9 onwards, consistent with surgical scar-mediated maxillary growth restriction. Mandibular growth patterns were comparable between groups. Dental arch width discrepancies were more pronounced in patients with palate repair timing beyond 18 months. The study provides the first Nigerian longitudinal cephalometric dataset for repaired UCLP and informs decisions on optimal surgical timing and future orthognathic intervention planning. Keywords: cleft lip and palate, craniofacial growth, cephalometric analysis, longitudinal study, Nigeria.