Growth in Children with Clefts: Serial Hand-Wrist X-Ray Evidence

Abstract

Objective Serial hand-wrist x-rays were assessed for Tanner-Whitehouse 2 skeletal ages of children with cleft palate, unilateral cleft lip and palate, and bilateral cleft lip and palate. The skeletal ages were compared by cleft type to see whether growth delay might explain the small body size for age and delayed maturation sometimes seen elsewhere in children with clefts. Design This is a retrospective study of serial x-rays collected between 1950 and 1968 at the Philadelphia Growth Center. The author was blind to age, sex, and diagnosis while reading these films. Participants These x-rays were taken as part of routine auxological evaluation of the normality of growth status. Main Outcome Measures Distributions of skeletal age patterns in advance of or delayed from chronological age and frequencies of clinically significant deviant patterns are presented. Conclusions Boys and girls with cleft palate show different maturational patterns, supporting a sex influence on the etiologies of at least some of these anomalies. Boys with unilateral cleft lip and palate and bilateral cleft lip and palate have different maturational patterns, consistent with these anomalies having different sets of etiological factors. Girls with unilateral cleft lip and palate almost always have advanced skeletal ages; whereas, boys sometimes do not. These results support the need for keeping both sex and diagnostic categories separate when conducting etiological searches.