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Page 4 of 10 Guagnano et al. Plast Aesthet Res 2020;7:37 I http://dx.doi.org/10.20517/2347-9264.2020.21

Statistical analysis
Data were recorded in a Microsoft Excel file and analysed using the Statistical Package for the Social
Sciences (SPSS), version 24.0 (SPSS, Inc., Chicago, IL, USA).

Values of quantitative variables are presented as the mean ± standard deviation, while values of categorical
variables are presented as frequencies and percentages.

Data were first examined for normality by the Shapiro-Wilk test and if the data did not achieve normality,
2
analyses were performed using non-parametric methods. The χ test was used to evaluate any potential
association between categorical variables and the one-way analysis of variance or the Kruskal-Wallis test
were used to assess differences of quantitative variables (Aine, Decayed Missing Filled Teeth index and
decayed missing filled teeth index) between gender, ethnicity, cleft types and timings of palate surgery, as
appropriate. When there were significant differences, pairwise multiple comparisons were carried out using
the Scheffé test or the Dunn test. Logistic regression models were used to analyse the associations between
surgical timings and dental anomalies. Estimates are shown as odds ratio (OR) and relative 95% confidence
intervals (CIs) adjusted for gender, age, ethnicity and type of cleft.

All tests were two-tailed and p values less than 0.05 were considered statistically significant.

RESULTS
In total, 85 cleft subjects (51 male and 34 female) aged from 3 to 18 years (mean age 9.7 ± 3.2 years) were
enrolled in the study, with 68 Caucasians (80%), 7 Asians (8.2%), 5 Hispanics (5.9%), 4 Africans (4.7%)
and 1 Indian (1.2%). All but 4 patients were systemically healthy, 1 suffered from heart disease, 1 referred
a transient ischemic attack at birth, 1 referred hyposmia due to pituitary gland dysfunction and 1 was
affected by a rare Tressier number 7 cleft and presented with bilateral cleft lip, right unilateral alveolar cleft
and cleft of the upper maxillary molar region on the right side with macrostomia.

Sixty-four patients were affected by CLP: 29 on the left side (L-UCLP), 20 on the right side (R-UCLP) and
15 bilaterally (BCLP). Ten patients presented with CP and eleven with CLA, with 8 cases on the left side, 1
case on the right side and 1 case bilaterally. The left side was significantly more often affected than the right
(P < 0.01). There was a statistical association between the type of cleft and gender with CLP more common
in males (67.2%) and CP in females (70%) (P = 0.047).

Sixty-one cleft patients (mean age 10.3 ± 3.3 years), belonging to the DPR group, had been treated at the
Plastic Surgery Division of the Regina Margherita Children Hospital of Turin between January 2002 and
December 2017. They underwent lip closure at a mean age of 6.1 ± 2.3 months, in combination with the
use of a neonatal palatal plate, soft palate closure at a mean age of 12.7 ± 4.3 months, hard palate closure at
4.4 ± 1.5 years and bone grafting at a mean age of 12.0 ± 1.6 years.

Twenty-one patients (mean age 7.8 ± 2.3 years) in the EPP group were referred from other cleft centres in
Italy: they all had been treated with a one-stage periosteal palatoplasty at a mean age of 7.2 ± 6.5 months
between January 2006 and December 2015, without using the palatal plate. No information about cleft
surgery was available for three patients.

Dental anomalies were assessed clinically and radiologically in 83 patients. The remaining two children
were younger than 6 years of age and were submitted only to intraoral examination for assessing the
presence of fused teeth. The frequencies of tooth anomalies by gender, ethnicity, cleft type and surgical
protocol among subjects aged 6-18 years are summarised in Table 1, while the distribution by tooth type is
described in Table 2.