Comparison of impact of three different methods of surgical palatal repair on maxillary growth in unilateral cleft lip and palate patients

Comparison of impact of three different methods of surgical palatal repair on maxillary growth in unilateral cleft lip and palate patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of impact of three different methods of surgical palatal repair on maxillary growth in unilateral cleft lip and palate patients Zahra Mohandes, Shabnam Ajami, Nasser Nadjmi, Maryam Salah This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6670378/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 16 You are reading this latest preprint version Abstract Aim: This study aimed to compare the effects of three different surgical palatal repair techniques on maxillary growth in patients with unilateral cleft lip and palate (UCLP). Materials and Methods: A total of 45 UCLP patients were divided into three groups, with each group receiving a different type of palatoplasty: 15 patients underwent modified Furlow palatoplasty, 15 received Sommerlad palatoplasty, and 15 underwent V-Y pushback surgery. A control group of 30 skeletal class I patients was selected. Lateral cephalograms were used for analysis. One-way ANOVA and Kruskal-Wallis tests were applied for multiple comparisons, while Tukey and Dunn tests were employed for pairwise comparisons. Results: The V-Y pushback group showed significantly lower S-N-A (P<0.05) and S-N-Ans (P<0.05) values, indicating reduced maxillary prominence and sagittal positioning compared to the control group. Although the modified Furlow group demonstrated higher S-N-A values, the differences were not statistically significant. Vertical dimension differences were generally insignificant across groups, except for the lower facial height-to-total facial height ratio. Significant variations were observed in soft tissue measurements. In contrast to lower dental variables, upper dental variables were significantly different among the compared groups. Conclusion: The findings suggest that the choice of surgical method can have significant impacts on craniofacial parameters, with the V-Y Pushback technique potentially being associated with a more retrognathic and hypoplastic maxilla. However, further research is needed to fully clarify the relative merits of the different approaches and identify the optimal treatment strategies for this complex condition. Cleft palatoplasty maxillary growth unilateral cleft lip and palate cephalometric analysis Figures Figure 1 Figure 2 Introduction Among all congenital deformities, oral clefts are considered one of the most common ( 1 ) that are formed between the fourth and ninth weeks of pregnancy due to the failure of embryonic facial processes to fuse properly ( 2 ). The etiology of clefts is believed to be multifactorial, involving a combination of genetic and environmental factors, such as tobacco smoke, alcohol, poor nutrition, viral infections, medicinal drugs, and teratogens ( 3 ). The most basic classification of orofacial clefts divides them into three groups: isolated cleft lip, cleft lip and palate (where the cleft extends from the upper lip to the hard or soft palate), and isolated cleft palate ( 4 ). Two-thirds of all clefts involve a cleft lip with or without a cleft palate, while one-third are isolated cleft palates ( 2 ). In the present study, we evaluated patients with complete unilateral cleft lip and palate (UCLP). In UCLP patients the cleft occurs on one side of the mouth, starts from the lip, involves the nostrils and is accompanied by an alveolar cleft ( 5 ), and continues by including both the primary and secondary palates in the palate area ( 6 ). The prevalence of oral clefts in Iran is reported to be 1.24 (1.1–1.38) per 1,000 births ( 7 ). Managing a child with cleft is challenging and requires the cooperation of a multidisciplinary team ( 8 ). The ideal surgical technique for repairing cleft lip and palate should restore functions such as speech, mastication, breathing, and aesthetics, while also promoting normal growth in the affected areas ( 9 ). However, maxillofacial growth is often adversely affected by surgical repair ( 10 – 12 ). Through substantial investigation, a strong link has been found between the surgical protocol, the skill of the surgeon, and the so-called effects of surgical repair ( 12 ). There has been considerable debate regarding the optimal surgical technique and timing of repair to ensure satisfactory maxillary development ( 13 ). Among the commonly used surgical methods are the V-Y pushback, modified Furlow, and Sommerlad palatoplasties, each with distinct surgical approaches. This study aimed to determine whether there is a palatoplasty surgical technique that has the best possible outcomes regarding maxillary growth in UCLP patients. In 1986, Furlow introduced a novel surgical technique for palate closure, which has gained widespread support due to its efficacy in restoring an effective muscular sling, achieving sufficient soft palate lengthening, and improving speech outcomes ( 14 – 16 ). However, limitations of the Furlow palatoplasty (FP), particularly in reconstructing wide palatal clefts where tension-free closure is not possible, have led surgeons to modify the technique ( 17 – 19 ). The modified Furlow technique is a two- stage surgery that can be performed in two ways. The first method involves minimal overlap of the levator muscle, rather than complete overlap of the myomucosal flaps. The second method incorporates a buccal myomucosal flap (BMF) to achieve tension-free closure of the oral layer, preventing exposure of raw surfaces in broader palatal clefts ( 20 ). The Sommerlad technique is a form of intravelar veloplasty, a one-stage palatoplasty designed to reconstruct the velum anatomy ( 21 ). Key components of this surgical repair include radical retropositioning of the velar, minimal hard palate dissection, a tensor tenotomy, and repair of the levator sling muscle ( 22 ). The Sommerlad technique has been shown to decrease velopharyngeal insufficiency and improve palatal function ( 21 ). The V-Y pushback technique is a one-stage surgical procedure that lengthens the palate by retropositioning the mucoperiosteal flaps ( 2 ). This can improve velopharyngeal competence, as the increased length of the palate helps seal the passage between the nasal and oral cavities during speech ( 23 ). However, a disadvantage of this technique is that the exposed membranous bone along the anterior alveolar margin can lead to scarring and midfacial growth deficiency ( 24 ). Given the varying impacts of different surgical techniques on maxillary growth, this study investigated the growth patterns of the maxilla in children with UCLP, according to the type of surgery: modified Furlow palatoplasty, Sommerlad palatoplasty, and V-Y pushback palatoplasty. We hypothesized that differences in surgical technique would be associated with measurable differences in cephalometric indicators of maxillary prominence, soft tissue profile, and jaw relationships. Materials and Methods From all the registered cases of complete UCLP patients at the Cleft Lip and Palate Center of the Orthodontic Research Center at Shiraz University of Medical Sciences, 45 eligible patient records were selected for inclusion in this retrospective, cross-sectional study. These cases were categorized post hoc into three groups based on the type of primary palatal repair previously performed: 15 patients were treated using modified Furlow palatoplasty, 15 underwent Sommerlad palatoplasty, and 15 had surgery via the V-Y pushback technique. No interventions were assigned by the investigators. The sample size was based on available eligible records; no formal power analysis was performed. Demographic information, including name, age, sex, type of cleft, time of surgery, and palatal surgery technique, was gathered from their medical records at the Cleft Lip and Palate Center and then organized. A control group was used to establish baseline cephalometric values representing normal craniofacial development, allowing comparative assessment of growth restriction associated with surgical repair in UCLP patients. The Cross-sectional control group were 30 healthy, skeletal class I non-syndromic children without cleft palate whose records were obtained from cases registered in the Orthodontic Department of Shiraz University of Medical Sciences. Then their demographic information, including name, age, sex was gathered and their lateral cephalograms were collected ( 13 ). The age in which the surgeries were conducted was different according to the type of palatoplasty technique and varied from 2 to 9 months for lip closure and 8 months to 3 years for palate closure. At the time the cephalograms were taken, all patients (both study and control group) were between 8 and 12 years of age. Inclusion criteria : Patients with non-syndromic, complete UCLP who underwent surgery using one of the three techniques—modified Furlow, V-Y pushback, or Sommerlad palatoplasty—were included. Exclusion criteria : Patients with a history of trauma, prior operations, or systemic diseases were excluded ( 25 ). All cephalometric radiographs were obtained using the same cephalostat, equal magnification, following standardized cephalometric guidelines, with the patients' heads in a natural position and teeth in centric occlusion. The cephalograms, taken with Orthopantomograph® OP200 devices (USA) registered in 2012, 2013, and 2014, were obtained using a maximum voltage of 85 kV ( 26 , 27 ). 21 anatomical reference points (15 hard tissue and 6 soft tissue) that are shown in Fig. 1 and are defined in Table 1 , were detected on each radiograph. The cephalometric variables shown in Tables 2 and 3 were measured. These landmarks and cephalometric variables were obtained from a previous study by Meazzini et al. ( 28 ). All measurements were performed by a trained general dentist who was blinded to group allocation throughout the measurement process ( 28 ). The angular measurements and ratios, particularly S-N-A, were compared across the three groups, and pairwise comparisons between the groups were also conducted ( 26 ). Table 1 Cephalometric landmarks on hard and soft tissues and definitions of them Definition Cephalometric landmarks Midpoint of the fossa hypophysealis (point of intersection between the maximum horizontal diameter and the maximum vertical diameter of the sella turcica) S (sellion) Most posteroinferior point of the clivus Ba (basion) Most anterior point of anteroposterior profile of the upper jaw Ans (anterior nasal spine) Most posterior point of the bony palate defined by the junction of the hard palate, the soft palate, and the extension of the pterygomaxillary fissure Pns (posterior nasal spine) Anterior point at the frontonasal suture N (nasion) Deepest anterior point in the concavity of the anterior maxilla A (subspinal) Deepest anterior point in the concavity of the anterior mandible B (supramental point) The most projecting point in the contour of the chin Pog (pogonion) Posterior ramus plane: the intersection of a line along the posterior border of the mandible and the inferior border of the basilar occipital bone Ar (articulare) Point of intersection between the line bisecting the posterior and inferior borders of the mandible and the contour of the chin Go (gonion) Point of intersection between the contour of the chin and the line bisecting the inferior border of the mandible and the line passing through N and Pg Gn (gnathion) Upper and lower incisor apex and incisal edge Api+/Ini+,Api-/Ini- Most posterior point at the frontonasal suture level on the soft tissues N’ (nasion) Tip of the nose on the soft tissues An (anterior nasalis) Point of intersection between the base of the nose and upper lip on the soft tissues Sn (subnasalis) Most posterior point in the anterior concavity of the upper lip on the soft tissues Ss (subspinale) Most posterior point in the anterior concavity of the lower lip Sm (supramentale) Most anterior point of the mandibular profile in the mental region on the soft tissues Pog’ (pogonion) Most inferior point of the mandibular profile in the mental region on the soft tissues Gn’ (gnathion) Most projecting point, on the frontal plane, of the upper lip Ls (labiale superioris) Table 2 Hard tissue and dental cephalometric measurements and definitions of them Definition cephalometric measurements Hard tissue Sagittal position of the maxilla relative to the anterior cranial base plane S-N S-N-A Sagittal position of the mandible related to the anterior cranial base plane S-N S-N-B Reciprocal relation between the upper and lower jaw on the sagittal plane A-N-B Facial angle from N to A to Pog on hard tissues N-A-Pog Mandibular prominence S-N-Pog Skeletal protrusion of anterior nasal spine S-N-Ans Angle from cranial base to N and S Ba-N-S Intermaxillary angle Pns-Ans^Go-Gn Gonial angle Ar-Go-Gn Craniomandibular angle S-N^Go-Gn Palatal plane inclination or craniospinal angle S-N^Pns-Ans Cranial base flexure angle Ba-S-N The ratio of the lower facial height to total face height Ans-Gn/N-Gn Dental measurements Upper incisor inclination to SN Api+/Ini+^S-N Upper incisor inclination to palatal plane Api+/Ini+^Pns-Ans Lower incisor inclination to mandibular plane Api-/Ini-^Go-Gn Table 3 Soft tissue cephalometric measurements and definitions of them Definition cephalometric measurements Soft tissue Corresponds to soft tissue S-N-B, with N on soft tissues S-N’-Sm Corresponds to soft tissue S-N-A, with N on soft tissues S-N’-Ss Corresponds to soft tissues ANB, with soft tissue nasal point Ss-N’-Sm Nasolabial angle An-Sn-Ls The upper lip’s thickness A-N-Ss Each cephalogram was analyzed manually and individually. The following equipment was used for the analysis: 1) A lateral cephalogram, measuring 8 x 10 inches, 2) Acetate matte tracing paper (0.003 inches thick, 8 x 10 inches), 3) A sharp 3H pencil or a fine-tipped felt pen, 4) Masking tape, 5) Black cardboard sheets (approximately 6 x 12 inches), and a hollow cardboard tube, and 6) A viewbox The process began by placing the cephalogram over the viewbox, ensuring the patient’s image was positioned to the right. The radiograph was secured to the viewbox using masking tape at the four corners. Three crosses were then marked on the radiograph—two within the cranium area and one on the cervical vertebra. These marks served as reference points to re-align the acetate tracing if needed. Afterward, the acetate film was placed over the radiograph, shiny side down, and taped firmly to both the radiograph and the viewbox. Once secured, the three registration crosses were traced, and the patient’s details, including name, age (in years and months), and the date of the cephalogram, were noted on the acetate. To trace the image lines, smooth and continuous pressure was applied, avoiding lifting or pausing with the pencil wherever possible ( 29 ). In manual tracing, the hard tissue, soft tissue, and dental landmarks were first identified by the dentist (operator) (Fig. 1 ). To re-evaluate and reach a consensus with the operator, the manual tracing was then checked by an orthodontist (blinded). Afterward, the required lines were drawn by the operator to measure the angles and ratios listed in Tables 2 and 3 . Once the angles and ratios were measured, the data was sent for statistical analysis. Statistical Method Statistical analysis was performed using SPSS software (version 27). For normally distributed data, the ANOVA test was used to evaluate the significance of differences, followed by a post-hoc Tukey test for pairwise comparisons. If the data was not normally distributed, the Kruskal Wallis test and Dunn post-hoc test were applied. The level of significance was set at p < 0.05. Method error was calculated by the Dahlberg formula ( 30 ) and was calculated less than 6% of the total variance for all variables. For intra-examiner reliability, one-third of the cases were blindly chosen and re-analyzed by the operator. The inter-examiner reliability test was not assessed. Results In general, the lateral cephalometric radiographs of 75 patients with a female/male ratio of 35/40 were assessed. The age of patients when the radiographs were taken ranged from 8 to 12 (mean = 8.746, SD = 1.412). Patients were divided in four groups, including 1: UCLP patients who underwent v-y palatoplasty (n = 15), 2: UCLP patients who underwent Modified Furlow palatoplasty (n = 15), 3: UCLP patients who underwent Sommerlad palatoplasty (n = 15) and 4: control group (n = 30) which consisted of patients who did not have any orofacial cleft and had a skeletal class I relation between their maxilla and mandible. Mean cephalometric values for all 21 variables, along with a comparison of significance across all groups, are shown in Tables 4 , 5 , and 6 . The significant levels for pairwise comparisons between groups are presented in Tables 7 , 8 , and 9 . Table 4 Mean cephalometric Measurements of hard tissue variables and comparison of significancy in V-Y, modified Furlow, Sommerlad and control group Cephalometric variables V-Y Pushback Modified Furlow Sommerlad control P value Hard tissue variables mean SD mean SD mean SD mean SD S-N-A 76.2° 3.1° 78.5° 3.1° 78.2° 3.9° 80.5° 4° .004 * S-N-B 74.8° 4.7° 73.7° 2.6° 74.8° 2.9° 77.2° 3.8° .017 * A-N-B 1.3° 4.9° 4.8° 3° 3.4° 3° 3.1° 1.1° .111 NS N-A-Pg 179.3° 10.5° 171.7° 6.8° 173.6° 6.6° 174° 3.8° .020 * S-N-Pg 75.8° 4.9° 73.9° 3° 75.3° 3.2° 77.6° 3.7° .019 * S-N-Ans 80.8° 4.1° 83.1° 2.8° 82.6° 3.8° 86° 4.8° .001 ** Ba-N-S 19.2° 2.6° 19.3° 2.4° 18.4° 3° 19.7° 2.7° .513 NS Ba-S-N 131.1° 6° 130.2° 4.7° 130.9° 7.2° 128.7° 5.2° .785 NS Pns-Ans^Go-Gn 24.4° 6.5° 24° 5.4° 23.1° 4.8° 23.1° 4.1° .817 NS Ar-Go-Gn 126.9° 6.2° 127.1° 7.1° 126° 3.9° 124.1° 3.8° .293 NS S-N^Go-Gn 35° 7.9° 34.6° 6° 33.6° 4.2° 31.4° 3.8° .186 NS S-N^Pns-Ans 10° 4.4° 10.7° 2.4° 10.6° 3.2° 8.5° 3.1° .096 NS Ans-Gn/N-Gn 56.4 4.8 57.1 2.4 56.9 3.6 54.5 2.8 0.29 * * p < 0.05 ** p < 0.01 *** p < 0.001 **** p = 0.00 Table 5 Mean cephalometric Measurements of soft tissue variables and comparison of significancy in V-Y, modified Furlow, Sommerlad and control group Cephalometric variables V-Y Pushback Modified Furlow Sommerlad control P value Soft tissue variables mean SD mean SD mean SD mean SD S-N’-Ss 80.5° 3.6° 81.9° 3.9° 81.5° 3.4° 87.8° 4.2° < .001 *** S-N’-Sm 77.2° 4.4° 76° 3.4° 77° 3° 80° 4.1° < .001 *** Ss-N’-Sm 3.3° 2.6° 5.9° 2.6° 4.5° 1.9° 7.2° 1.5° < .001 *** An-Sn-Ls 115.3° 13.6° 123.2° 12.3° 118.1° 11.4° 126.1° 10.6° .021 *** A-N-Ss 10.6° 3.1° 8.8° 2.4° 9.4° 2.7° 12.5° 1.6° < .001 * * p < 0.05 ** p < 0.01 *** p < 0.001 **** p = 0.00 Table 6 Mean cephalometric Measurements of dental variables and comparison of significancy in V-Y, modified Furlow, Sommerlad and control group Cephalometric variables V-Y Pushback Modified Furlow Sommerlad control P value Dental variables mean SD mean SD mean SD mean SD Api+/Ini+^S-N 93° 8° 94.4° 6.3° 89.2° 6.6° 103.7° 9° < .001 *** Api+/Ini+^Pns-Ans 102.4° 9.2° 104.2° 7.8° 99.3° 5.8° 111.6° 8.3° < .001 *** Api-/Ini-^Go-Gn 94.9° 6.6° 98.1° 8.1° 92.4° 5.5° 96.9° 5.6° 0.69 NS * p < 0.05 ** p < 0.01 *** p < 0.001 **** p = 0.00 Hard Tissue Variables Anteroposterior dimensions Two angles that represent maxillary prominence and sagittal position—S-N-A and S-N-Ans—were significantly different and lower in the V-Y group compared to the control group. This suggests that patients who underwent V-Y Pushback palatoplasty had more maxillary deficiency (Table 4 , Table 7 and Fig. 2 ). A significant difference was also observed in the S-N-B and S-N-Pg angles between the modified Furlow group and the control group (Table 4 , Table 7 ). The facial angle (N-A-Pg) was significantly different between the modified Furlow group and the V-Y group, with the V-Y group showing higher values (Table 4 , Table 7 ). There was no significant difference in cranial base angulation (Ba-S-N) or Ba-N-S angle across the groups (Table 4 , Table 7 ). Although the sagittal jaw relationship did not show significant differences across the four groups (P value: 0.111), the A-N-B angle was smallest in the V-Y group (Table 4 , Table 7 ). Vertical dimensions There were no significant difference in intermaxillary angles (Pns-Ans^Go-Gn), gonial angles (Ar-Go-Gn), craniomandibular angles (S-N^Go-Gn), or palatal plane inclination (S-N^Pns-Ans) among the groups (p > 0.05). In terms of vertical position of the maxilla and mandible, no significant differences were observed (Table 4 , Table 7 ). However, there was a significant difference in the ratio of lower facial height to total facial height (Ans-Gn/N-Gn) between the modified Furlow and control groups, as well as between the Sommerlad and control groups. This ratio was significantly higher in both study groups compared to the control group (Table 4 , Table 7 ). Table 7 Binary comparison of hard tissue variables between V-Y, modified Furlow, Sommerlad and control group Hard tissue variables S-N-A V-Y MF sommerlad control V-Y - NS NS ** MF NS - NS NS Sommerlad NS NS - NS control ** NS NS - S-N-B V-Y - NS NS NS MF NS - NS * Sommerlad NS NS - NS control NS * NS - A-N-B V-Y - NS NS NS MF NS - NS NS Sommerlad NS NS - NS control NS NS NS - N-A-Pg V-Y - * NS NS MF * - NS NS Sommerlad NS NS - NS control NS NS NS - S-N-Pg V-Y - NS NS NS MF NS - NS * Sommerlad NS NS - NS control NS * NS - S-N-Ans V-Y - NS NS *** MF NS - NS NS Sommerlad NS NS - NS control *** NS NS - Ba-N-S V-Y - NS NS NS MF NS - NS NS Sommerlad NS NS - NS control NS NS NS - Ba-S-N V-Y - NS NS NS MF NS - NS NS Sommerlad NS NS - NS control NS NS NS - Pns-Ans^Go-Gn V-Y - NS NS NS MF NS - NS NS Sommerlad NS NS - NS control NS NS NS - Ar-Go-Gn V-Y - NS NS NS MF NS - NS NS Sommerlad NS NS - NS control NS NS NS - S-N^Go-Gn V-Y - NS NS NS MF NS - NS NS Sommerlad NS NS - NS control NS NS NS - S-N^Pns-Ans V-Y - NS NS NS MF NS - NS NS Sommerlad NS NS - NS control NS NS NS - Ans-Gn/N-Gn V-Y - NS NS NS MF NS - NS ** Sommerlad NS NS - * control NS ** * - * p < 0.05 ** p < 0.01 *** p < 0.001 **** p = 0.00 Soft Tissue Variables The sagittal relationship (S-N’-Ss, S-N’-Sm) was significantly different between each study group and the control group. Among the three groups, the modified Furlow group had a higher mean S-N’-Ss value than the other two groups, but this difference was not statistically significant (Table 5 and Table 8 ). The sagittal relationship between the lips (Ss-N’-Sm) showed significant differences between the V-Y group and the control group, between the Sommerlad group and the control group, and between the V-Y and modified Furlow groups. This angle was highest in the control group, followed by the modified Furlow group, the Sommerlad group, and finally the V-Y group, which had the lowest values (Table 5 and Table 8 ). The nasolabial angle (An-Sn-Ls) was significantly lower in the V-Y group compared to the control group. The differences between the other groups were not significant (Table 5 and Table 8 ). There was a significant difference in upper lip thickness (A-N-Ss) between the Sommerlad group and the control group, as well as between the modified Furlow group and the control group. The modified Furlow group exhibited the lowest upper lip thickness, while the V-Y group had the highest values, which were more similar to those of the control group (Table 5 and Table 8 ). Table 8 Binary comparison of soft tissue variables between V-Y, modified Furlow, Sommerlad and control group Soft tissue variables V-Y MF sommerlad control S-N’-Ss V-Y - NS NS *** MF NS - NS *** Sommerlad NS NS - *** control *** *** *** - S-N’-Sm V-Y - NS NS * MF NS - NS ** Sommerlad NS NS - * control ** * * - Ss-N’-Sm V-Y - * NS **** MF * - NS NS Sommerlad NS NS - ** control **** NS ** - An-Sn-Ls V-Y - NS NS * MF NS - NS NS Sommerlad NS NS - NS control * NS NS - A-N-Ss V-Y - NS NS NS MF NS - NS *** Sommerlad NS NS - *** control NS *** *** - * p < 0.05 ** p < 0.01 *** p < 0.001 **** p = 0.00 Dental Variables The upper incisor inclination to the S-N plane (Api+/Ini+^S-N) and the upper incisor inclination to the palatal plane (Api+/Ini+^Pns-Ans) were significantly different between each study group and the control group. The mean angle of upper incisor inclination to both the S-N plane and the palatal plane was lower in each study group compared to the control group, indicating retrusion of the upper incisors. Among the three groups, patients in the modified Furlow group had the least amount of upper incisor retrusion. The lower incisor inclination to the mandibular plane did not show any significant differences among the groups (p > 0.05) (Table 6 and Table 9 ). Table 9 Binary comparison of dental variables between V-Y, modified Furlow, Sommerlad and control group Dental variables V-Y MF sommerlad control Api+/Ini+^S-N V-Y - NS NS *** MF NS - NS ** Sommerlad NS NS - *** control *** ** *** - Api+/Ini+^Pns-Ans V-Y - NS NS ** MF NS - NS * Sommerlad NS NS - *** control ** * *** - Api-/Ini-^Go-Gn V-Y - NS NS NS MF NS - NS NS Sommerlad NS NS - NS control NS NS NS - * p < 0.05 ** p < 0.01 *** p < 0.001 **** p = 0.00 Discussion The influence of various surgical techniques—such as the timing of the operation, the order of cleft closure, and the application of presurgical orthopedics—on the craniofacial growth and development in children with complete UCLP has been extensively researched ( 31 ). This research aimed to compare the effects of three different surgical approaches including the V-Y Pushback method, the modified Furlow method, and the Sommerlad method on craniofacial morphology of UCLP children. Our results highlight the significant influence of surgical technique on maxillary development, especially in the sagittal dimension. The results indicate that patients who underwent V-Y pushback palatoplasty exhibited significantly lower S-N-A (P < 0.05) and S-N-Ans (P < 0.05) values, which are cephalometric parameters reflecting maxillary prominence and sagittal positioning, compared to the control group. In contrast, the modified Furlow group showed more favorable sagittal positioning, though not statistically significant. The lower values noted in the V-Y group indicate a tendency toward maxillary deficiency and retrognathia. This could be attributed to the design of the mucoperiosteal flap in the V-Y pushback palatoplasty, where the flaps are repositioned medially and posteriorly, exposing large sections of bone on both sides of the hard palate. The resulting scarring in these areas likely plays a role in hindering midfacial growth ( 23 ). In contrast, the modified Furlow method seems to cause less scarring, leading to fewer adverse effects on maxillary growth. This finding is consistent with previous researches by Yamanishi et al. ( 13 ) and Kitagawa et al. ( 18 ) who reported poorer dentoalveolar growth outcomes in patients who underwent one-stage pushback procedures compared to two-stage techniques. Both studies measured relevant variables using dental casts. Liao’s cephalometric findings ( 32 ) further supports these findings by showing reduced maxillary length and protrusion in one-stage palatal compared to two-stage repair with delayed hard palate closure. However, some studies, including those by Filho O ( 33 ). and Zemann et al. ( 34 ), found no significant differences in maxillary sagittal growth among surgical protocols. These discrepancies could be the result of varying surgical timing, operator skill, adjunct therapies, and patient-specific growth patterns. Since no significant differences were found in vertical maxillary position or inclination (S-N^Pns-Ans), nor in intermaxillary(Pns-Ans^Go-Gn), gonial(Ar-Go-Gn), or craniomandibular angles(S-N^Go-Gn), it was assumed that vertical skeletal dimensions were unaffected by the surgical technique, which is supported by a study of Liao et al. ( 32 ), but differs from the results of Bakri et al. ( 35 ). However, the significantly lower S-N-B and S-N-Pg angles observed in the modified Furlow group suggest a more retrognathic mandible a finding also reported by by Gaggle et al. ( 26 ) and Zemann et al. ( 34 ). These differences, although subtle, could reflect compensatory mandibular positioning in response to maxillary development. The smallest A-N-B angle and highest N-A-Pg angle were seen in the V-Y group, indicating a stronger Class III skeletal tendency among groups, similar to the findings of Iwasaki et al. ( 23 ) and Liao et al. ( 36 ). According to our findings, this was likely due to maxillary retrusion rather than mandibular prognathism. Such skeletal patterns have implications for future orthodontic and orthognathic treatment planning. Soft tissue measurements (S-N’-Ss and Ss-N’-Sm) mirrored the skeletal findings, with the modified Furlow group exhibiting more favorable soft tissue profiles. A more developed maxilla in the sagittal dimension leads to greater protrusion, which in turn affects the soft tissue, resulting in more pronounced features and higher S-n-ss and ss-n-sm values. These parameters are clinically important as they influence facial aesthetics and lip posture. A more prominent maxilla, as seen in the modified Furlow group, supports better soft tissue projection. This finding aligns with the study by Mommaerts MY et al. ( 37 ). The An-Sn-Ls angle comprises two components: the upper component, influenced by nose position, and the lower component, influenced by upper lip position. Our analysis revealed a significant difference in this angle between the V-Y group and the control group. Children with UCLP typically exhibit common soft tissue features such as a shortened upper lip ( 38 ) and a flattened nasal appearance ( 39 ). The mean nasolabial angle in the V-Y group was 115.3°, compared to 126.1° in the control group. This difference can be explained in two ways: ( 1 ) the lower nasolabial angle in V-Y patients may be due to a lower nose position, possibly a consequence of this palatoplasty technique, or ( 2 ) less maxillary development (lower S-N-A and S-N’-Ss values), as observed in the V-Y group, may ultimately cause higher nasolabial angles. The first explanation seems more plausible in interpreting the An-Sn-Ls angle results. In a study by Meazzini ( 28 ), the nasolabial angle was not statistically different among compared groups. In Nollet’s longitudinal study ( 40 ), which investigated craniofacial morphology in UCLP patients who underwent delayed hard palate closure, nose flattening (ns-unt/NSL) was not observed; however, the nasolabial angle (nst-sn-ls) showed a significant increase with age. These changes may have both aesthetic and functional consequences, including altered lip seal and nasal airflow. The thinner upper lip (A-N-Ss) observed in cleft groups, especially the modified Furlow cohort (mean thickness of 8.8° compared to the control group, with a mean of 12.5°.), may reflect surgical tension and underlying bone volume discrepancies. It is essential to recognize that soft-tissue cephalometric assessments rely heavily on patient cooperation, as it is critical for the patient to maintain relaxed lips while radiography is being taken ( 40 ). Regarding dental patterns, the upper incisor inclination relative to both the S-N plane and palatal plane was significantly different between each surgical group and the control group, with the V-Y group showing the lowest values and the control group the highest. It is understandable that the lower, less favorable results in the V-Y group are due to increased lip strain following lip closure in this palatoplasty technique. While some literature support this finding (Iwasaki’s study ( 23 )), others (e.g., Liao’s 2005 study ( 36 )) report no impact of surgical technique on incisor inclination, likely attributed to the specific methods employed. Based on our measurements, mandibular incisor inclination to the mandibular plane did not show any significant differences between the groups. Liao’s study ( 36 ) yielded similar results when comparing the effects of palatal repair in UCLP patients who only underwent lip repair with those who underwent both lip and palate surgery. As mentioned earlier, there was a stronger Class III tendency in the V-Y group compared to the other groups. The more Class III a patient's jaw relationship is, the greater their lower facial height tends to be. This could explain why the ratio of lower facial height to total facial height was higher in both the V-Y and Sommerlad groups compared to the control group. These findings align with Meazzini’s study ( 28 ) comparing surgical centers. Clinical Implication Our findings highlight the significant impact of various surgical techniques on the craniofacial growth and development of children with complete UCLP. The comparative analysis of the V-Y Pushback, modified Furlow, and Sommerlad methods reveals distinct differences in outcomes, particularly with regard to maxillary development and jaw relationships. While the modified Furlow technique demonstrated more favorable results in terms of maxillary growth and soft tissue profiles, the V-Y method was associated with a marked tendency toward retrognathia and Class III relationships. These findings underscore the critical importance of careful surgical protocol selection, based on the individual needs of the patient and the expected outcomes. Drawbacks and Limitations One of the limitations of this study was the small sample size of patients in each group. Moreover, its cross-sectional design prevents assessment of growth over time. Additionally, manual tracing of all lateral cephalograms, though carefully conducted, was very time consuming. Inter-examiner reliability was not formally assessed. Finally, functional outcomes such as speech, breathing, and mastication were not evaluated, which limits broader clinical applicability. Future Suggestions It is recommended that future studies include a larger sample size to better evaluate the surgical effects of different palatoplasty techniques. It is also suggested that precise and accurate cephalometric analysis software be used instead of manual tracing to improve the reliability of measurements and speed up the process. Integrating functional outcomes, especially speech and velopharyngeal function, would reinforce the clinical relevance of growth-focused studies on UCLP surgical techniques. Conclusion This study provides valuable insights into the effects of three common palatal repair techniques on maxillary growth and development in UCLP patients. The findings suggest that the choice of surgical method can significantly impact craniofacial parameters, with the V-Y Pushback technique potentially being associated with a more retrognathic and hypoplastic maxilla. Therefore, it is recommended that the use of this palatoplasty technique should be limited in UCLP patients. However, further research is needed to fully elucidate the relative merits of the different surgical approaches and to identify the optimal treatment strategies for this complex condition. Continued evaluation of treatment outcomes and refinement of surgical techniques will be crucial for improving the long-term quality of life for individuals born with UCLP. Declarations Ethics approval and consent to participate - This study was reviewed and approved by the Ethics Committee of Shiraz University of Medical Sciences with the approval number: IR.SUMS.DENTAL.REC.1403.036, dated 2024/07/24. -Additionally, patient demographic data were obtained from the Cleft Lip and Palate Registry System (Registry Code: IR.SUMS.REC.1401.108), a secure and approved database used for clinical and research purposes at Cleft Lip and Palate Center of the Orthodontic Research Center at Shiraz University of Medical Sciences. -All lateral cephalograms (from both the control and sample groups) were available in the patients' files, so no additional cephalograms were needed for this study. The patients’ data was accessed from 1 August to 22 September of 2024 for our research purposes. - This study was conducted in accordance with the principles of the Declaration of Helsinki. -All the patients in our study were under the age of 16, therefore written informed consent was obtained from all patients’ parents or their legal guardians, allowing the use of their information for research purposes. Consent for publication: - Not applicable. Availability of data and materials: The research data associated with our study has not been deposited into any publicly available repository. The data will be made available on request. Competing interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Funding: This work was supported by Shiraz University of Medical Science (Grant#30370). Acknowledgments : The authors thank the Vice-Chancellery of Research Shiraz University of Medical Science for supporting this research (Grant#30370). This article is based on the thesis by Dr Zahra Mohandes. The authors also thank Dr. Asmarian of the Dental Research Development Center, of the School of Dentistry for the statistical analysis. References Strong E, Buckmiller L. Management of the cleft palate. Facial Plast Surg Clin North Am. 2001;9(1):15–25. vii. Farronato G, Kairyte L, Giannini L, Galbiati G, Maspero C. How various surgical protocols of the unilateral cleft lip and palate influence the facial growth and possible orthodontic problems? Which is the best timing of lip, palate and alveolus repair? Literature review. Stomatologija. 2014;16(2):53–60. Mossey PA, Little J, Munger RG, Dixon MJ, Shaw WC. Cleft lip and palate. Lancet. 2009;374(9703):1773–85. Nasreddine G, El Hajj J, Ghassibe-Sabbagh M. Orofacial clefts embryology, classification, epidemiology, and genetics. Mutat Research/Reviews Mutat Res. 2021;787:108373. Suzuki S, Marazita ML, Cooper ME, Miwa N, Hing A, Jugessur A, et al. Mutations in BMP4 are associated with subepithelial, microform, and overt cleft lip. Am J Hum Genet. 2009;84(3):406–11. Shkoukani MA, Chen M, Vong A. Cleft lip–a comprehensive review. Front Pead. 2013;1:53. Haseli A, Hajimirzaie S, Bagheri L, Sadeghian A, Ahmadnia E. Prevalence of cleft lip and cleft palate in Iran: A systematic review and meta-analysis. J Mazandaran Univ Med Sci. 2019;28(168):185–97. Stein MJ, Zhang Z, Fell M, Mercer N, Malic C. Determining postoperative outcomes after cleft palate repair: a systematic review and meta-analysis. J Plast Reconstr aesthetic Surg. 2019;72(1):85–91. Shi B, Losee JE. The impact of cleft lip and palate repair on maxillofacial growth. Int J Oral Sci. 2015;7(1):14–7. Friede H. Growth sites and growth mechanisms at risk in cleft lip and palate. Acta Odontol Scand. 1998;56(6):346–51. Semb G, Shaw WC. Facial growth after different methods of surgical intervention in patients with cleft lip and palate. Acta Odontol Scand. 1998;56(6):352–5. Shaw WC, Dahl E, Asher-McDade C, Brattström V, Mars M, McWilliam J, et al. A six-center international study of treatment outcome in patients with clefts of the lip and palate: Part 5. General discussion and conclusions. Cleft palate-craniofacial J. 1992;29(5):413–8. Yamanishi T, Nishio J, Kohara H, Hirano Y, Sako M, Yamanishi Y, et al. Effect on maxillary arch development of early 2-stage palatoplasty by modified furlow technique and conventional 1-stage palatoplasty in children with complete unilateral cleft lip and palate. J Oral Maxillofac Surg. 2009;67(10):2210–6. Furlow LT Jr. Cleft palate repair by double opposing Z-plasty. Plast Reconstr Surg. 1986;78(6):724–38. Guneren E, Uysal OA. The quantitative evaluation of palatal elongation after Furlow palatoplasty. J Oral Maxillofac Surg. 2004;62(4):446–50. Gunther E, Wisser J, Cohen M, Brown A, Palatoplasty. Furlow's double reversing Z-plasty versus intravelar veloplasty. Cleft palate-craniofacial J. 1998;35(6):546–9. Horswell BB, Castiglione CL, Poole AE, Assael LA. The double-reversing Z-plasty in primary palatoplasty: Operative experience and early results. J Oral Maxillofac Surg. 1993;51(2):145–9. Kitagawa T, Kohara H, Sohmura T, Takahashi J, Tachimura T, Wada T et al. Dentoalveolar growth of patients with complete unilateral cleft lip and palate by early two-stage Furlow and push-back method: preliminary results. The Cleft palate-craniofacial journal. 2004;41(5):519–25. Furlow LT Jr. Flaps for cleft lip and palate surgery. Clin Plast Surg. 1990;17(4):633–44. Nadjmi N, Van Erum R, De Bodt M, Bronkhorst E. Two-stage palatoplasty using a modified Furlow procedure. Int J Oral Maxillofac Surg. 2013;42(5):551–8. Sommerlad BC. A technique for cleft palate repair. Plast Reconstr Surg. 2003;112(6):1542–8. Bruneel L, Bettens K, De Bodt M, Roche N, Bonte K, Van Lierde K. Speech outcomes following Sommerlad primary palatoplasty: results of the Ghent University Hospital. J Commun Disord. 2018;72:111–21. Iwasaki K, Yamamoto YS, Masuda M, Nalabothu P, Ohkubo F, Kadomatsu K, et al. Longitudinal Follow-Up of Facial Growth of Patients With Unilateral Cleft Lip and Palate Following Modified Veau–Wardill–Kilner Palatoplasty. Cleft Palate-Craniofacial J. 2022;59(3):291–8. GM D. JW B. The push-back operation for repair of cleft palate. Plastic and Reconstructive Surgery (1946). 1946;1:145 – 69. Dissaux C, Grollemund B, Bodin F, Picard A, Vazquez M-P, Morand B, et al. Evaluation of 5-year-old children with complete cleft lip and palate: Multicenter study. Part 2: Functional results. J Cranio-Maxillofacial Surg. 2016;44(2):94–103. Gaggl A, Feichtinger M, Schultes G, Santler G, Pichlmaier M, Mossböck R, et al. Cephalometric and occlusal outcome in adults with unilateral cleft lip, palate, and alveolus after two different surgical techniques. Cleft palate-craniofacial J. 2003;40(3):249–55. Liao Y-F, Prasad N, Chiu Y-T, Yun C, Chen P-T. Cleft size at the time of palate repair in complete unilateral cleft lip and palate as an indicator of maxillary growth. Int J Oral Maxillofac Surg. 2010;39(10):956–61. Meazzini MC, Giussani G, Morabito A, Semb G, Garattini G, Brusati R. A cephalometric intercenter comparison of patients with unilateral cleft lip and palate: analysis at 5 and 10 years of age and long term. Cleft palate-craniofacial J. 2008;45(6):654–60. Jacobson A. Tracing technique and identification of landmarks. Radiographic Cephalometry. From Basics to 3D Imaging. 4. UK: Quintessence Publishing Co. Limited, New Malden, Surrey, UK;; 2006. p. 320. Kim H-Y. Statistical notes for clinical researchers: Evaluation of measurement error 2: Dahlberg's error, Bland-Altman method, and Kappa coefficient. Restor dentistry endodontics. 2013;38(3):182–5. Kulewicz M, Dudkiewicz Z. Craniofacial morphological outcome following treatment with three different surgical protocols for complete unilateral cleft lip and palate: a premilinary study. Int J Oral Maxillofac Surg. 2010;39(2):122–8. Liao Y-F, Yang I-Y, Wang R, Yun C, Huang C-S. Two-stage palate repair with delayed hard palate closure is related to favorable maxillary growth in unilateral cleft lip and palate. Plast Reconstr Surg. 2010;125(5):1503–10. Gabriel da Silva Filho O, Calvano F, Alcoforado Assunção AG, de Oliveira Cavassan A. Craniofacial morphology in children with complete unilateral cleft lip and palate: a comparison of two surgical protocols. Angle Orthod. 2001;71(4):274–84. Zemann W, Kärcher H, Drevenšek M, Koželj V. Sagittal maxillary growth in children with unilateral cleft of the lip, alveolus and palate at the age of 10 years: an intercentre comparison. J Cranio-Maxillofacial Surg. 2011;39(7):469–74. Bakri S, Rizell S, Lilja J, Mark H. Vertical maxillary growth after two different surgical protocols in unilateral cleft lip and palate patients. Cleft Palate-Craniofacial J. 2014;51(6):645–50. Liao Y-F, Mars M. Long-term effects of palate repair on craniofacial morphology in patients with unilateral cleft lip and palate. Cleft palate-craniofacial J. 2005;42(6):594–600. Mommaerts MY, Kablan F, Sheth S, Laster Z. Early maxillary growth in complete cleft lip, alveolus and palate patients following Widmaier-Perko's, or a modified Furlow's technique of soft palate repair. J Cranio-Maxillofacial Surg. 2003;31(4):209–14. Smahel Z, Müllerová Z. Craniofacial morphology in unilateral cleft lip and palate prior to palatoplasty. Cleft palate J. 1986;23(3):225–32. Sadowsky C, Aduss H, Pruzansky S. The soft tissue profile in unilateral clefts. Angle Orthod. 1973;43(3):233–46. Nollet P, Katsaros C, Huyskens R, Borstlap W, Bronkhorst E, Kuijpers-Jagtman A. Cephalometric evaluation of long-term craniofacial development in unilateral cleft lip and palate patients treated with delayed hard palate closure. Int J Oral Maxillofac Surg. 2008;37(2):123–30. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 10 Feb, 2026 Reviews received at journal 12 Oct, 2025 Reviews received at journal 11 Oct, 2025 Reviews received at journal 10 Oct, 2025 Reviews received at journal 06 Oct, 2025 Reviewers agreed at journal 03 Oct, 2025 Reviewers agreed at journal 02 Oct, 2025 Reviewers agreed at journal 01 Oct, 2025 Reviews received at journal 28 Sep, 2025 Reviewers agreed at journal 27 Sep, 2025 Reviewers agreed at journal 26 Sep, 2025 Reviewers invited by journal 03 Jul, 2025 Editor assigned by journal 11 Jun, 2025 Editor invited by journal 03 Jun, 2025 Submission checks completed at journal 30 May, 2025 First submitted to journal 30 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6670378","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":480139019,"identity":"ea055830-193a-4df9-8842-cbca0f483ce6","order_by":0,"name":"Zahra Mohandes","email":"","orcid":"","institution":"Shiraz University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Zahra","middleName":"","lastName":"Mohandes","suffix":""},{"id":480139020,"identity":"7d01eaf3-b85d-40fe-971e-3215a0b1b8ac","order_by":1,"name":"Shabnam Ajami","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIie3RMWsCMRTA8RcexCVc1hfOfgfl4HDSryIUOh0uTqWFCoJjP07mA0GX6Cxk6dUvoIOii/SFtuvddROaPzkuHPnBJQGIxe6xkh8CUDzEB89V8heCvUBkK/KdkhRejSTxpTgMXm0X9Gb1fCqGXQlYfe5qiNmOkWjlFdDkyT/YR/4xmWVFDek53grJQFTujUUmSqYNBC90Y6JdPjX2rRWRZBZMoMjF0S6biXFiMTDvno+ryFJh10piw14Sh0tPZz/S2vWPV/sy0p15ta8jAGKG4T7CdaAKH7B2+Q86/E4uLVbHYrHY/+sLWsk9QezqDSQAAAAASUVORK5CYII=","orcid":"","institution":"Shiraz University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Shabnam","middleName":"","lastName":"Ajami","suffix":""},{"id":480139022,"identity":"13f6301a-f191-41d1-ad60-c2180da7a9ee","order_by":2,"name":"Nasser Nadjmi","email":"","orcid":"","institution":"Shiraz University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Nasser","middleName":"","lastName":"Nadjmi","suffix":""},{"id":480139023,"identity":"694053f1-eb9e-46e0-ad5b-d688fc13a4bc","order_by":3,"name":"Maryam Salah","email":"","orcid":"","institution":"Shiraz University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Maryam","middleName":"","lastName":"Salah","suffix":""}],"badges":[],"createdAt":"2025-05-15 08:23:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6670378/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6670378/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86216782,"identity":"e25363fd-c6d1-4971-9bb3-54ac350ebfa8","added_by":"auto","created_at":"2025-07-08 06:09:53","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":69514,"visible":true,"origin":"","legend":"\u003cp\u003eReference points on the lateral cephalometric film\u003c/p\u003e","description":"","filename":"Fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6670378/v1/0cf20724c29d700e1f3b3062.jpg"},{"id":86216092,"identity":"0a26a10a-0b61-40f2-a29e-9399018c6bc8","added_by":"auto","created_at":"2025-07-08 06:01:53","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":99777,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of S-N-A and S-N-Ans values among four groups\u003c/p\u003e","description":"","filename":"Fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6670378/v1/5e00e9209c9231420c35bd72.jpg"},{"id":86218313,"identity":"3d21c3b2-402f-4d59-abc1-4f3f65b88d0c","added_by":"auto","created_at":"2025-07-08 06:25:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1500820,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6670378/v1/c8847bbd-edaa-43ac-b67b-3bc74939586a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of impact of three different methods of surgical palatal repair on maxillary growth in unilateral cleft lip and palate patients","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAmong all congenital deformities, oral clefts are considered one of the most common (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) that are formed between the fourth and ninth weeks of pregnancy due to the failure of embryonic facial processes to fuse properly (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The etiology of clefts is believed to be multifactorial, involving a combination of genetic and environmental factors, such as tobacco smoke, alcohol, poor nutrition, viral infections, medicinal drugs, and teratogens (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The most basic classification of orofacial clefts divides them into three groups: isolated cleft lip, cleft lip and palate (where the cleft extends from the upper lip to the hard or soft palate), and isolated cleft palate (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Two-thirds of all clefts involve a cleft lip with or without a cleft palate, while one-third are isolated cleft palates (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In the present study, we evaluated patients with complete unilateral cleft lip and palate (UCLP). In UCLP patients the cleft occurs on one side of the mouth, starts from the lip, involves the nostrils and is accompanied by an alveolar cleft (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), and continues by including both the primary and secondary palates in the palate area (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The prevalence of oral clefts in Iran is reported to be 1.24 (1.1\u0026ndash;1.38) per 1,000 births (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eManaging a child with cleft is challenging and requires the cooperation of a multidisciplinary team (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The ideal surgical technique for repairing cleft lip and palate should restore functions such as speech, mastication, breathing, and aesthetics, while also promoting normal growth in the affected areas (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). However, maxillofacial growth is often adversely affected by surgical repair (\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Through substantial investigation, a strong link has been found between the surgical protocol, the skill of the surgeon, and the so-called effects of surgical repair (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). There has been considerable debate regarding the optimal surgical technique and timing of repair to ensure satisfactory maxillary development (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Among the commonly used surgical methods are the V-Y pushback, modified Furlow, and Sommerlad palatoplasties, each with distinct surgical approaches. This study aimed to determine whether there is a palatoplasty surgical technique that has the best possible outcomes regarding maxillary growth in UCLP patients.\u003c/p\u003e\u003cp\u003eIn 1986, Furlow introduced a novel surgical technique for palate closure, which has gained widespread support due to its efficacy in restoring an effective muscular sling, achieving sufficient soft palate lengthening, and improving speech outcomes (\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). However, limitations of the Furlow palatoplasty (FP), particularly in reconstructing wide palatal clefts where tension-free closure is not possible, have led surgeons to modify the technique (\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The modified Furlow technique is a two- stage surgery that can be performed in two ways. The first method involves minimal overlap of the levator muscle, rather than complete overlap of the myomucosal flaps. The second method incorporates a buccal myomucosal flap (BMF) to achieve tension-free closure of the oral layer, preventing exposure of raw surfaces in broader palatal clefts (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe Sommerlad technique is a form of intravelar veloplasty, a one-stage palatoplasty designed to reconstruct the velum anatomy (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Key components of this surgical repair include radical retropositioning of the velar, minimal hard palate dissection, a tensor tenotomy, and repair of the levator sling muscle (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). The Sommerlad technique has been shown to decrease velopharyngeal insufficiency and improve palatal function (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe V-Y pushback technique is a one-stage surgical procedure that lengthens the palate by retropositioning the mucoperiosteal flaps (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). This can improve velopharyngeal competence, as the increased length of the palate helps seal the passage between the nasal and oral cavities during speech (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). However, a disadvantage of this technique is that the exposed membranous bone along the anterior alveolar margin can lead to scarring and midfacial growth deficiency (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eGiven the varying impacts of different surgical techniques on maxillary growth, this study investigated the growth patterns of the maxilla in children with UCLP, according to the type of surgery: modified Furlow palatoplasty, Sommerlad palatoplasty, and V-Y pushback palatoplasty. We hypothesized that differences in surgical technique would be associated with measurable differences in cephalometric indicators of maxillary prominence, soft tissue profile, and jaw relationships.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eFrom all the registered cases of complete UCLP patients at the Cleft Lip and Palate Center of the Orthodontic Research Center at Shiraz University of Medical Sciences, 45 eligible patient records were selected for inclusion in this retrospective, cross-sectional study. These cases were categorized post hoc into three groups based on the type of primary palatal repair previously performed: 15 patients were treated using modified Furlow palatoplasty, 15 underwent Sommerlad palatoplasty, and 15 had surgery via the V-Y pushback technique. No interventions were assigned by the investigators. The sample size was based on available eligible records; no formal power analysis was performed. Demographic information, including name, age, sex, type of cleft, time of surgery, and palatal surgery technique, was gathered from their medical records at the Cleft Lip and Palate Center and then organized. A control group was used to establish baseline cephalometric values representing normal craniofacial development, allowing comparative assessment of growth restriction associated with surgical repair in UCLP patients. The Cross-sectional control group were 30 healthy, skeletal class I non-syndromic children without cleft palate whose records were obtained from cases registered in the Orthodontic Department of Shiraz University of Medical Sciences. Then their demographic information, including name, age, sex was gathered and their lateral cephalograms were collected (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The age in which the surgeries were conducted was different according to the type of palatoplasty technique and varied from 2 to 9 months for lip closure and 8 months to 3 years for palate closure. At the time the cephalograms were taken, all patients (both study and control group) were between 8 and 12 years of age.\u003c/p\u003e\u003cp\u003e\u003cb\u003eInclusion criteria\u003c/b\u003e: Patients with non-syndromic, complete UCLP who underwent surgery using one of the three techniques\u0026mdash;modified Furlow, V-Y pushback, or Sommerlad palatoplasty\u0026mdash;were included. \u003cb\u003eExclusion criteria\u003c/b\u003e: Patients with a history of trauma, prior operations, or systemic diseases were excluded (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e All cephalometric radiographs were obtained using the same cephalostat, equal magnification, following standardized cephalometric guidelines, with the patients' heads in a natural position and teeth in centric occlusion. The cephalograms, taken with Orthopantomograph\u0026reg; OP200 devices (USA) registered in 2012, 2013, and 2014, were obtained using a maximum voltage of 85 kV (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e21 anatomical reference points (15 hard tissue and 6 soft tissue) that are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and are defined in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, were detected on each radiograph. The cephalometric variables shown in Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e were measured. These landmarks and cephalometric variables were obtained from a previous study by Meazzini et al. (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). All measurements were performed by a trained general dentist who was blinded to group allocation throughout the measurement process (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). The angular measurements and ratios, particularly S-N-A, were compared across the three groups, and pairwise comparisons between the groups were also conducted (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCephalometric landmarks on hard and soft tissues and definitions of them\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDefinition\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCephalometric landmarks\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMidpoint of the fossa hypophysealis (point of intersection between the maximum horizontal diameter and the maximum vertical diameter of the sella turcica)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eS (sellion)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMost posteroinferior point of the clivus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBa (basion)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMost anterior point of anteroposterior profile of the upper jaw\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAns (anterior nasal spine)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMost posterior point of the bony palate defined by the junction of the hard palate, the soft palate, and the extension of the pterygomaxillary fissure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePns (posterior nasal spine)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnterior point at the frontonasal suture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN (nasion)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDeepest anterior point in the concavity of the anterior maxilla\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA (subspinal)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDeepest anterior point in the concavity of the anterior mandible\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB (supramental point)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe most projecting point in the contour of the chin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePog (pogonion)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePosterior ramus plane: the intersection of a line along the posterior border of the mandible and the inferior border of the basilar occipital bone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAr (articulare)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePoint of intersection between the line bisecting the posterior and inferior borders of the mandible and the contour of the chin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGo (gonion)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePoint of intersection between the contour of the chin and the line bisecting the inferior border of the mandible and the line passing through N and Pg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGn (gnathion)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUpper and lower incisor apex and incisal edge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eApi+/Ini+,Api-/Ini-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMost posterior point at the frontonasal suture level on the soft tissues\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN\u0026rsquo; (nasion)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTip of the nose on the soft tissues\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAn (anterior nasalis)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePoint of intersection between the base of the nose and upper lip on the soft tissues\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSn (subnasalis)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMost posterior point in the anterior concavity of the upper lip on the soft tissues\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSs (subspinale)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMost posterior point in the anterior concavity of the lower lip\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSm (supramentale)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMost anterior point of the mandibular profile in the mental region on the soft tissues\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePog\u0026rsquo; (pogonion)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMost inferior point of the mandibular profile in the mental region on the soft tissues\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGn\u0026rsquo; (gnathion)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMost projecting point, on the frontal plane, of the upper lip\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLs (labiale superioris)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eHard tissue and dental cephalometric measurements and definitions of them\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDefinition\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ecephalometric measurements\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eHard tissue\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSagittal position of the maxilla relative to the anterior cranial base plane S-N\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eS-N-A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSagittal position of the mandible related to the anterior cranial base plane S-N\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eS-N-B\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReciprocal relation between the upper and lower jaw on the sagittal plane\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA-N-B\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFacial angle from N to A to Pog on hard tissues\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN-A-Pog\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMandibular prominence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eS-N-Pog\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSkeletal protrusion of anterior nasal spine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eS-N-Ans\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAngle from cranial base to N and S\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBa-N-S\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntermaxillary angle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePns-Ans^Go-Gn\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGonial angle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAr-Go-Gn\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCraniomandibular angle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eS-N^Go-Gn\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePalatal plane inclination or craniospinal angle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eS-N^Pns-Ans\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCranial base flexure angle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBa-S-N\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe ratio of the lower facial height to total face height\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAns-Gn/N-Gn\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eDental measurements\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUpper incisor inclination to SN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eApi+/Ini+^S-N\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUpper incisor inclination to palatal plane\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eApi+/Ini+^Pns-Ans\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLower incisor inclination to mandibular plane\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eApi-/Ini-^Go-Gn\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSoft tissue cephalometric measurements and definitions of them\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDefinition\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ecephalometric measurements\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eSoft tissue\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCorresponds to soft tissue S-N-B, with N on soft tissues\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eS-N\u0026rsquo;-Sm\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCorresponds to soft tissue S-N-A, with N on soft tissues\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eS-N\u0026rsquo;-Ss\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCorresponds to soft tissues ANB, with soft tissue nasal point\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSs-N\u0026rsquo;-Sm\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNasolabial angle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAn-Sn-Ls\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe upper lip\u0026rsquo;s thickness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA-N-Ss\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eEach cephalogram was analyzed manually and individually. The following equipment was used for the analysis: 1) A lateral cephalogram, measuring 8 x 10 inches, 2) Acetate matte tracing paper (0.003 inches thick, 8 x 10 inches), 3) A sharp 3H pencil or a fine-tipped felt pen, 4) Masking tape, 5) Black cardboard sheets (approximately 6 x 12 inches), and a hollow cardboard tube, and 6) A viewbox\u003c/p\u003e\u003cp\u003eThe process began by placing the cephalogram over the viewbox, ensuring the patient\u0026rsquo;s image was positioned to the right. The radiograph was secured to the viewbox using masking tape at the four corners. Three crosses were then marked on the radiograph\u0026mdash;two within the cranium area and one on the cervical vertebra. These marks served as reference points to re-align the acetate tracing if needed. Afterward, the acetate film was placed over the radiograph, shiny side down, and taped firmly to both the radiograph and the viewbox. Once secured, the three registration crosses were traced, and the patient\u0026rsquo;s details, including name, age (in years and months), and the date of the cephalogram, were noted on the acetate. To trace the image lines, smooth and continuous pressure was applied, avoiding lifting or pausing with the pencil wherever possible (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn manual tracing, the hard tissue, soft tissue, and dental landmarks were first identified by the dentist (operator) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). To re-evaluate and reach a consensus with the operator, the manual tracing was then checked by an orthodontist (blinded). Afterward, the required lines were drawn by the operator to measure the angles and ratios listed in Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Once the angles and ratios were measured, the data was sent for statistical analysis.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eStatistical Method\u003c/strong\u003e\u003cp\u003eStatistical analysis was performed using SPSS software (version 27). For normally distributed data, the ANOVA test was used to evaluate the significance of differences, followed by a post-hoc Tukey test for pairwise comparisons. If the data was not normally distributed, the Kruskal Wallis test and Dunn post-hoc test were applied. The level of significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Method error was calculated by the Dahlberg formula (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) and was calculated less than 6% of the total variance for all variables. For intra-examiner reliability, one-third of the cases were blindly chosen and re-analyzed by the operator. The inter-examiner reliability test was not assessed.\u003c/p\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn general, the lateral cephalometric radiographs of 75 patients with a female/male ratio of 35/40 were assessed. The age of patients when the radiographs were taken ranged from 8 to 12 (mean\u0026thinsp;=\u0026thinsp;8.746, SD\u0026thinsp;=\u0026thinsp;1.412). Patients were divided in four groups, including 1: UCLP patients who underwent v-y palatoplasty (n\u0026thinsp;=\u0026thinsp;15), 2: UCLP patients who underwent Modified Furlow palatoplasty (n\u0026thinsp;=\u0026thinsp;15), 3: UCLP patients who underwent Sommerlad palatoplasty (n\u0026thinsp;=\u0026thinsp;15) and 4: control group (n\u0026thinsp;=\u0026thinsp;30) which consisted of patients who did not have any orofacial cleft and had a skeletal class I relation between their maxilla and mandible.\u003c/p\u003e\n\u003cp\u003eMean cephalometric values for all 21 variables, along with a comparison of significance across all groups, are shown in Tables \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e, \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e, and \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e. The significant levels for pairwise comparisons between groups are presented in Tables \u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e, \u003cspan class=\"InternalRef\"\u003e8\u003c/span\u003e, and \u003cspan class=\"InternalRef\"\u003e9\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMean cephalometric Measurements of hard tissue variables and comparison of significancy in V-Y, modified Furlow, Sommerlad and control group\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCephalometric variables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eV-Y Pushback\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eModified Furlow\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSommerlad\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003econtrol\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eHard tissue variables\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003emean\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003emean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003emean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003emean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS-N-A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76.2\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.1\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78.5\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.1\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78.2\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.9\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80.5\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS-N-B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74.8\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.7\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73.7\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.6\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74.8\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.9\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.2\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.8\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA-N-B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.3\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.9\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.8\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.4\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.1\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.1\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN-A-Pg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e179.3\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.5\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e171.7\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.8\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e173.6\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.6\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e174\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.8\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS-N-Pg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75.8\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.9\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73.9\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75.3\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.2\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.6\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.7\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS-N-Ans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80.8\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.1\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83.1\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.8\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82.6\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.8\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.8\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBa-N-S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.2\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.6\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.3\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.4\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.4\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.7\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.7\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.513\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBa-S-N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e131.1\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e130.2\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.7\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e130.9\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.2\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e128.7\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.2\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.785\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePns-Ans^Go-Gn\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.4\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.5\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.4\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.1\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.8\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.1\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.1\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.817\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAr-Go-Gn\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e126.9\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.2\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e127.1\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.1\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e126\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.9\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e124.1\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.8\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.293\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS-N^Go-Gn\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.9\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.6\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.6\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.2\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.4\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.8\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS-N^Pns-Ans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.4\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.7\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.4\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.6\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.2\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.5\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.1\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.096\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAns-Gn/N-Gn\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e* p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\n\u003cp\u003e** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n\u003cp\u003e*** p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003cp\u003e**** p\u0026thinsp;=\u0026thinsp;0.00\u003c/p\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\n \u003cdiv id=\"Sec7\" class=\"Section4\"\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMean cephalometric Measurements of soft tissue variables and comparison of significancy in V-Y, modified Furlow, Sommerlad and control group\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCephalometric variables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eV-Y Pushback\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eModified Furlow\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSommerlad\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003econtrol\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eSoft tissue variables\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003emean\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003emean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003emean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003emean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS-N\u0026rsquo;-Ss\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e80.5\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.6\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81.9\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.9\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81.5\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.4\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87.8\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.2\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS-N\u0026rsquo;-Sm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e77.2\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.4\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.4\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.1\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSs-N\u0026rsquo;-Sm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.3\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.6\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.9\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.6\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.5\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.9\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.2\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.5\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAn-Sn-Ls\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e115.3\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.6\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e123.2\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.3\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e118.1\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.4\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e126.1\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.6\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA-N-Ss\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.6\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.1\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.8\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.4\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.4\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.7\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.5\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.6\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003c/div\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003cp\u003e* p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\n \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\n \u003cp\u003e** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003cdiv id=\"Sec10\" class=\"Section4\"\u003e\n \u003cp\u003e*** p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e**** p\u0026thinsp;=\u0026thinsp;0.00\u003c/em\u003e\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMean cephalometric Measurements of dental variables and comparison of significancy in V-Y, modified Furlow, Sommerlad and control group\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCephalometric variables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eV-Y Pushback\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eModified Furlow\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSommerlad\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003econtrol\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eDental variables\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003emean\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003emean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003emean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003emean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eApi+/Ini+^S-N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e94.4\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.3\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e89.2\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.6\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e103.7\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eApi+/Ini+^Pns-Ans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e102.4\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.2\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e104.2\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.8\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e99.3\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.8\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e111.6\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.3\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eApi-/Ini-^Go-Gn\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94.9\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.6\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e98.1\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.1\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e92.4\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.5\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e96.9\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.6\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003c/div\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003cp\u003e* p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\n \u003cp\u003e** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003cp\u003e*** p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003cdiv id=\"Sec13\" class=\"Section4\"\u003e\n \u003cp\u003e\u003cem\u003e**** p\u0026thinsp;=\u0026thinsp;0.00\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003eHard Tissue Variables\u003c/h2\u003e\n \u003cp\u003e\u003cstrong\u003eAnteroposterior dimensions\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eTwo angles that represent maxillary prominence and sagittal position\u0026mdash;S-N-A and S-N-Ans\u0026mdash;were significantly different and lower in the V-Y group compared to the control group. This suggests that patients who underwent V-Y Pushback palatoplasty had more maxillary deficiency (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e, Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eA significant difference was also observed in the S-N-B and S-N-Pg angles between the modified Furlow group and the control group (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e, Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eThe facial angle (N-A-Pg) was significantly different between the modified Furlow group and the V-Y group, with the V-Y group showing higher values (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e, Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eThere was no significant difference in cranial base angulation (Ba-S-N) or Ba-N-S angle across the groups (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e, Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eAlthough the sagittal jaw relationship did not show significant differences across the four groups (P value: 0.111), the A-N-B angle was smallest in the V-Y group (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e, Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eVertical dimensions\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThere were no significant difference in intermaxillary angles (Pns-Ans^Go-Gn), gonial angles (Ar-Go-Gn), craniomandibular angles (S-N^Go-Gn), or palatal plane inclination (S-N^Pns-Ans) among the groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). In terms of vertical position of the maxilla and mandible, no significant differences were observed (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e, Table \u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e). However, there was a significant difference in the ratio of lower facial height to total facial height (Ans-Gn/N-Gn) between the modified Furlow and control groups, as well as between the Sommerlad and control groups. This ratio was significantly higher in both study groups compared to the control group (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e, Table \u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e).\u0026nbsp;\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab7\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBinary comparison of hard tissue variables between V-Y, modified Furlow, Sommerlad and control group\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eHard tissue variables\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" align=\"left\"\u003e\n \u003cp\u003eS-N-A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eV-Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003esommerlad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003econtrol\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eV-Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSommerlad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003econtrol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003eS-N-B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eV-Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSommerlad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003econtrol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003eA-N-B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eV-Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSommerlad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003econtrol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003eN-A-Pg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eV-Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSommerlad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003econtrol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003eS-N-Pg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eV-Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSommerlad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003econtrol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003eS-N-Ans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eV-Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSommerlad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003econtrol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003eBa-N-S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eV-Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSommerlad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003econtrol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003eBa-S-N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eV-Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSommerlad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003econtrol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003ePns-Ans^Go-Gn\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eV-Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSommerlad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003econtrol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003eAr-Go-Gn\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eV-Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSommerlad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003econtrol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003eS-N^Go-Gn\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eV-Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSommerlad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003econtrol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003eS-N^Pns-Ans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eV-Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSommerlad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003econtrol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003eAns-Gn/N-Gn\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eV-Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSommerlad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003econtrol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003cp\u003e* p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\n \u003cp\u003e** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003cp\u003e*** p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003cdiv id=\"Sec17\" class=\"Section4\"\u003e\n \u003cp\u003e\u003cem\u003e**** p\u0026thinsp;=\u0026thinsp;0.00\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n \u003ch2\u003eSoft Tissue Variables\u003c/h2\u003e\n \u003cp\u003eThe sagittal relationship (S-N\u0026rsquo;-Ss, S-N\u0026rsquo;-Sm) was significantly different between each study group and the control group. Among the three groups, the modified Furlow group had a higher mean S-N\u0026rsquo;-Ss value than the other two groups, but this difference was not statistically significant (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e and Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eThe sagittal relationship between the lips (Ss-N\u0026rsquo;-Sm) showed significant differences between the V-Y group and the control group, between the Sommerlad group and the control group, and between the V-Y and modified Furlow groups. This angle was highest in the control group, followed by the modified Furlow group, the Sommerlad group, and finally the V-Y group, which had the lowest values (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e and Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eThe nasolabial angle (An-Sn-Ls) was significantly lower in the V-Y group compared to the control group. The differences between the other groups were not significant (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e and Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eThere was a significant difference in upper lip thickness (A-N-Ss) between the Sommerlad group and the control group, as well as between the modified Furlow group and the control group. The modified Furlow group exhibited the lowest upper lip thickness, while the V-Y group had the highest values, which were more similar to those of the control group (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e and Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab8\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBinary comparison of soft tissue variables between V-Y, modified Furlow, Sommerlad and control group\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eSoft tissue variables\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eV-Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003esommerlad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003econtrol\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003eS-N\u0026rsquo;-Ss\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eV-Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSommerlad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003econtrol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003eS-N\u0026rsquo;-Sm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eV-Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSommerlad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003econtrol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003eSs-N\u0026rsquo;-Sm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eV-Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e****\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSommerlad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003econtrol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e****\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003eAn-Sn-Ls\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eV-Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSommerlad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003econtrol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003eA-N-Ss\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eV-Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSommerlad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003econtrol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n \u003cp\u003e* p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\n \u003cdiv id=\"Sec20\" class=\"Section3\"\u003e\n \u003cp\u003e** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003cp\u003e*** p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e**** p\u0026thinsp;=\u0026thinsp;0.00\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec22\" class=\"Section3\"\u003e\n \u003ch2\u003eDental Variables\u003c/h2\u003e\n \u003cp\u003eThe upper incisor inclination to the S-N plane (Api+/Ini+^S-N) and the upper incisor inclination to the palatal plane (Api+/Ini+^Pns-Ans) were significantly different between each study group and the control group. The mean angle of upper incisor inclination to both the S-N plane and the palatal plane was lower in each study group compared to the control group, indicating retrusion of the upper incisors. Among the three groups, patients in the modified Furlow group had the least amount of upper incisor retrusion. The lower incisor inclination to the mandibular plane did not show any significant differences among the groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e and Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e9\u003c/span\u003e).\u0026nbsp;\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab9\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 9\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBinary comparison of dental variables between V-Y, modified Furlow, Sommerlad and control group\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eDental variables\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eV-Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003esommerlad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003econtrol\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003eApi+/Ini+^S-N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eV-Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSommerlad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003econtrol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003eApi+/Ini+^Pns-Ans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eV-Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSommerlad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003econtrol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003eApi-/Ini-^Go-Gn\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eV-Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSommerlad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003econtrol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\n \u003cp\u003e* p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\n \u003cp\u003e** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e*** p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cp\u003e**** p\u0026thinsp;=\u0026thinsp;0.00\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe influence of various surgical techniques\u0026mdash;such as the timing of the operation, the order of cleft closure, and the application of presurgical orthopedics\u0026mdash;on the craniofacial growth and development in children with complete UCLP has been extensively researched (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). This research aimed to compare the effects of three different surgical approaches including the V-Y Pushback method, the modified Furlow method, and the Sommerlad method on craniofacial morphology of UCLP children. Our results highlight the significant influence of surgical technique on maxillary development, especially in the sagittal dimension.\u003c/p\u003e\u003cp\u003eThe results indicate that patients who underwent V-Y pushback palatoplasty exhibited significantly lower S-N-A (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and S-N-Ans (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) values, which are cephalometric parameters reflecting maxillary prominence and sagittal positioning, compared to the control group. In contrast, the modified Furlow group showed more favorable sagittal positioning, though not statistically significant. The lower values noted in the V-Y group indicate a tendency toward maxillary deficiency and retrognathia. This could be attributed to the design of the mucoperiosteal flap in the V-Y pushback palatoplasty, where the flaps are repositioned medially and posteriorly, exposing large sections of bone on both sides of the hard palate. The resulting scarring in these areas likely plays a role in hindering midfacial growth (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). In contrast, the modified Furlow method seems to cause less scarring, leading to fewer adverse effects on maxillary growth. This finding is consistent with previous researches by Yamanishi et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) and Kitagawa et al. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) who reported poorer dentoalveolar growth outcomes in patients who underwent one-stage pushback procedures compared to two-stage techniques. Both studies measured relevant variables using dental casts. Liao\u0026rsquo;s cephalometric findings (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) further supports these findings by showing reduced maxillary length and protrusion in one-stage palatal compared to two-stage repair with delayed hard palate closure. However, some studies, including those by Filho O (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). and Zemann et al. (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), found no significant differences in maxillary sagittal growth among surgical protocols. These discrepancies could be the result of varying surgical timing, operator skill, adjunct therapies, and patient-specific growth patterns.\u003c/p\u003e\u003cp\u003eSince no significant differences were found in vertical maxillary position or inclination (S-N^Pns-Ans), nor in intermaxillary(Pns-Ans^Go-Gn), gonial(Ar-Go-Gn), or craniomandibular angles(S-N^Go-Gn), it was assumed that vertical skeletal dimensions were unaffected by the surgical technique, which is supported by a study of Liao et al. (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), but differs from the results of Bakri et al. (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). However, the significantly lower S-N-B and S-N-Pg angles observed in the modified Furlow group suggest a more retrognathic mandible a finding also reported by by Gaggle et al. (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) and Zemann et al. (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). These differences, although subtle, could reflect compensatory mandibular positioning in response to maxillary development.\u003c/p\u003e\u003cp\u003eThe smallest A-N-B angle and highest N-A-Pg angle were seen in the V-Y group, indicating a stronger Class III skeletal tendency among groups, similar to the findings of Iwasaki et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) and Liao et al. (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). According to our findings, this was likely due to maxillary retrusion rather than mandibular prognathism. Such skeletal patterns have implications for future orthodontic and orthognathic treatment planning.\u003c/p\u003e\u003cp\u003eSoft tissue measurements (S-N\u0026rsquo;-Ss and Ss-N\u0026rsquo;-Sm) mirrored the skeletal findings, with the modified Furlow group exhibiting more favorable soft tissue profiles. A more developed maxilla in the sagittal dimension leads to greater protrusion, which in turn affects the soft tissue, resulting in more pronounced features and higher S-n-ss and ss-n-sm values. These parameters are clinically important as they influence facial aesthetics and lip posture. A more prominent maxilla, as seen in the modified Furlow group, supports better soft tissue projection. This finding aligns with the study by Mommaerts MY et al. (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe An-Sn-Ls angle comprises two components: the upper component, influenced by nose position, and the lower component, influenced by upper lip position. Our analysis revealed a significant difference in this angle between the V-Y group and the control group. Children with UCLP typically exhibit common soft tissue features such as a shortened upper lip (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e) and a flattened nasal appearance (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). The mean nasolabial angle in the V-Y group was 115.3\u0026deg;, compared to 126.1\u0026deg; in the control group. This difference can be explained in two ways: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) the lower nasolabial angle in V-Y patients may be due to a lower nose position, possibly a consequence of this palatoplasty technique, or (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) less maxillary development (lower S-N-A and S-N\u0026rsquo;-Ss values), as observed in the V-Y group, may ultimately cause higher nasolabial angles. The first explanation seems more plausible in interpreting the An-Sn-Ls angle results. In a study by Meazzini (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), the nasolabial angle was not statistically different among compared groups. In Nollet\u0026rsquo;s longitudinal study (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e), which investigated craniofacial morphology in UCLP patients who underwent delayed hard palate closure, nose flattening (ns-unt/NSL) was not observed; however, the nasolabial angle (nst-sn-ls) showed a significant increase with age. These changes may have both aesthetic and functional consequences, including altered lip seal and nasal airflow.\u003c/p\u003e\u003cp\u003eThe thinner upper lip (A-N-Ss) observed in cleft groups, especially the modified Furlow cohort (mean thickness of 8.8\u0026deg; compared to the control group, with a mean of 12.5\u0026deg;.), may reflect surgical tension and underlying bone volume discrepancies. It is essential to recognize that soft-tissue cephalometric assessments rely heavily on patient cooperation, as it is critical for the patient to maintain relaxed lips while radiography is being taken (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRegarding dental patterns, the upper incisor inclination relative to both the S-N plane and palatal plane was significantly different between each surgical group and the control group, with the V-Y group showing the lowest values and the control group the highest. It is understandable that the lower, less favorable results in the V-Y group are due to increased lip strain following lip closure in this palatoplasty technique. While some literature support this finding (Iwasaki\u0026rsquo;s study (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)), others (e.g., Liao\u0026rsquo;s 2005 study (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e)) report no impact of surgical technique on incisor inclination, likely attributed to the specific methods employed.\u003c/p\u003e\u003cp\u003eBased on our measurements, mandibular incisor inclination to the mandibular plane did not show any significant differences between the groups. Liao\u0026rsquo;s study (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e) yielded similar results when comparing the effects of palatal repair in UCLP patients who only underwent lip repair with those who underwent both lip and palate surgery.\u003c/p\u003e\u003cp\u003eAs mentioned earlier, there was a stronger Class III tendency in the V-Y group compared to the other groups. The more Class III a patient's jaw relationship is, the greater their lower facial height tends to be. This could explain why the ratio of lower facial height to total facial height was higher in both the V-Y and Sommerlad groups compared to the control group. These findings align with Meazzini\u0026rsquo;s study (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) comparing surgical centers.\u003c/p\u003e\u003cdiv id=\"Sec27\" class=\"Section2\"\u003e\u003ch2\u003eClinical Implication\u003c/h2\u003e\u003cp\u003eOur findings highlight the significant impact of various surgical techniques on the craniofacial growth and development of children with complete UCLP. The comparative analysis of the V-Y Pushback, modified Furlow, and Sommerlad methods reveals distinct differences in outcomes, particularly with regard to maxillary development and jaw relationships. While the modified Furlow technique demonstrated more favorable results in terms of maxillary growth and soft tissue profiles, the V-Y method was associated with a marked tendency toward retrognathia and Class III relationships. These findings underscore the critical importance of careful surgical protocol selection, based on the individual needs of the patient and the expected outcomes.\u003c/p\u003e\u003cdiv id=\"Sec28\" class=\"Section3\"\u003e\u003ch2\u003eDrawbacks and Limitations\u003c/h2\u003e\u003cp\u003eOne of the limitations of this study was the small sample size of patients in each group. Moreover, its cross-sectional design prevents assessment of growth over time. Additionally, manual tracing of all lateral cephalograms, though carefully conducted, was very time consuming. Inter-examiner reliability was not formally assessed. Finally, functional outcomes such as speech, breathing, and mastication were not evaluated, which limits broader clinical applicability.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec29\" class=\"Section3\"\u003e\u003ch2\u003eFuture Suggestions\u003c/h2\u003e\u003cp\u003eIt is recommended that future studies include a larger sample size to better evaluate the surgical effects of different palatoplasty techniques. It is also suggested that precise and accurate cephalometric analysis software be used instead of manual tracing to improve the reliability of measurements and speed up the process. Integrating functional outcomes, especially speech and velopharyngeal function, would reinforce the clinical relevance of growth-focused studies on UCLP surgical techniques.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides valuable insights into the effects of three common palatal repair techniques on maxillary growth and development in UCLP patients. The findings suggest that the choice of surgical method can significantly impact craniofacial parameters, with the V-Y Pushback technique potentially being associated with a more retrognathic and hypoplastic maxilla. Therefore, it is recommended that the use of this palatoplasty technique should be limited in UCLP patients. However, further research is needed to fully elucidate the relative merits of the different surgical approaches and to identify the optimal treatment strategies for this complex condition. Continued evaluation of treatment outcomes and refinement of surgical techniques will be crucial for improving the long-term quality of life for individuals born with UCLP.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003eThis study was reviewed and approved by the Ethics Committee of Shiraz University of Medical Sciences with the approval number: IR.SUMS.DENTAL.REC.1403.036, dated 2024/07/24.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e-Additionally, patient demographic data were obtained from the Cleft Lip and Palate Registry System (Registry Code: IR.SUMS.REC.1401.108), a secure and approved database used for clinical and research purposes at Cleft Lip and Palate Center of the Orthodontic Research Center at Shiraz University of Medical Sciences.\u003c/p\u003e\n\u003cp\u003e-All lateral cephalograms (from both the control and sample groups) were available in the patients' files, so no additional cephalograms were needed for this study. The patients’ data was accessed from 1 August to 22 September of 2024 for our research purposes.\u003c/p\u003e\n\u003cp\u003e- This study was conducted in accordance with the principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e-All the patients in our study were under the age of 16, therefore written informed consent was obtained from all patients’ parents or their legal guardians, allowing the use of their information for research purposes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e- Not applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe research data associated with our study has not been deposited into any publicly available repository. The data will be made available on request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis work was supported by\u0026nbsp;Shiraz University of Medical Science\u0026nbsp;(Grant#30370).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e: The authors thank the Vice-Chancellery of Research Shiraz University of Medical Science for supporting this research (Grant#30370). This article is based on the thesis by Dr Zahra Mohandes. The authors also thank Dr. Asmarian of the Dental Research Development Center, of the School of Dentistry for the statistical analysis.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eStrong E, Buckmiller L. Management of the cleft palate. Facial Plast Surg Clin North Am. 2001;9(1):15\u0026ndash;25. vii.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFarronato G, Kairyte L, Giannini L, Galbiati G, Maspero C. How various surgical protocols of the unilateral cleft lip and palate influence the facial growth and possible orthodontic problems? Which is the best timing of lip, palate and alveolus repair? Literature review. Stomatologija. 2014;16(2):53\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMossey PA, Little J, Munger RG, Dixon MJ, Shaw WC. Cleft lip and palate. Lancet. 2009;374(9703):1773\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNasreddine G, El Hajj J, Ghassibe-Sabbagh M. Orofacial clefts embryology, classification, epidemiology, and genetics. Mutat Research/Reviews Mutat Res. 2021;787:108373.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSuzuki S, Marazita ML, Cooper ME, Miwa N, Hing A, Jugessur A, et al. Mutations in BMP4 are associated with subepithelial, microform, and overt cleft lip. Am J Hum Genet. 2009;84(3):406\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShkoukani MA, Chen M, Vong A. Cleft lip\u0026ndash;a comprehensive review. Front Pead. 2013;1:53.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHaseli A, Hajimirzaie S, Bagheri L, Sadeghian A, Ahmadnia E. Prevalence of cleft lip and cleft palate in Iran: A systematic review and meta-analysis. J Mazandaran Univ Med Sci. 2019;28(168):185\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStein MJ, Zhang Z, Fell M, Mercer N, Malic C. Determining postoperative outcomes after cleft palate repair: a systematic review and meta-analysis. J Plast Reconstr aesthetic Surg. 2019;72(1):85\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShi B, Losee JE. The impact of cleft lip and palate repair on maxillofacial growth. Int J Oral Sci. 2015;7(1):14\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFriede H. Growth sites and growth mechanisms at risk in cleft lip and palate. Acta Odontol Scand. 1998;56(6):346\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSemb G, Shaw WC. Facial growth after different methods of surgical intervention in patients with cleft lip and palate. Acta Odontol Scand. 1998;56(6):352\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShaw WC, Dahl E, Asher-McDade C, Brattstr\u0026ouml;m V, Mars M, McWilliam J, et al. A six-center international study of treatment outcome in patients with clefts of the lip and palate: Part 5. General discussion and conclusions. Cleft palate-craniofacial J. 1992;29(5):413\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYamanishi T, Nishio J, Kohara H, Hirano Y, Sako M, Yamanishi Y, et al. Effect on maxillary arch development of early 2-stage palatoplasty by modified furlow technique and conventional 1-stage palatoplasty in children with complete unilateral cleft lip and palate. J Oral Maxillofac Surg. 2009;67(10):2210\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFurlow LT Jr. Cleft palate repair by double opposing Z-plasty. Plast Reconstr Surg. 1986;78(6):724\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGuneren E, Uysal OA. The quantitative evaluation of palatal elongation after Furlow palatoplasty. J Oral Maxillofac Surg. 2004;62(4):446\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGunther E, Wisser J, Cohen M, Brown A, Palatoplasty. Furlow's double reversing Z-plasty versus intravelar veloplasty. Cleft palate-craniofacial J. 1998;35(6):546\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHorswell BB, Castiglione CL, Poole AE, Assael LA. The double-reversing Z-plasty in primary palatoplasty: Operative experience and early results. J Oral Maxillofac Surg. 1993;51(2):145\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKitagawa T, Kohara H, Sohmura T, Takahashi J, Tachimura T, Wada T et al. Dentoalveolar growth of patients with complete unilateral cleft lip and palate by early two-stage Furlow and push-back method: preliminary results. The Cleft palate-craniofacial journal. 2004;41(5):519\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFurlow LT Jr. Flaps for cleft lip and palate surgery. Clin Plast Surg. 1990;17(4):633\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNadjmi N, Van Erum R, De Bodt M, Bronkhorst E. Two-stage palatoplasty using a modified Furlow procedure. Int J Oral Maxillofac Surg. 2013;42(5):551\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSommerlad BC. A technique for cleft palate repair. Plast Reconstr Surg. 2003;112(6):1542\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBruneel L, Bettens K, De Bodt M, Roche N, Bonte K, Van Lierde K. Speech outcomes following Sommerlad primary palatoplasty: results of the Ghent University Hospital. J Commun Disord. 2018;72:111\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIwasaki K, Yamamoto YS, Masuda M, Nalabothu P, Ohkubo F, Kadomatsu K, et al. Longitudinal Follow-Up of Facial Growth of Patients With Unilateral Cleft Lip and Palate Following Modified Veau\u0026ndash;Wardill\u0026ndash;Kilner Palatoplasty. Cleft Palate-Craniofacial J. 2022;59(3):291\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGM D. JW B. The push-back operation for repair of cleft palate. Plastic and Reconstructive Surgery (1946). 1946;1:145\u0026thinsp;\u0026ndash;\u0026thinsp;69.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDissaux C, Grollemund B, Bodin F, Picard A, Vazquez M-P, Morand B, et al. Evaluation of 5-year-old children with complete cleft lip and palate: Multicenter study. Part 2: Functional results. J Cranio-Maxillofacial Surg. 2016;44(2):94\u0026ndash;103.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGaggl A, Feichtinger M, Schultes G, Santler G, Pichlmaier M, Mossb\u0026ouml;ck R, et al. Cephalometric and occlusal outcome in adults with unilateral cleft lip, palate, and alveolus after two different surgical techniques. Cleft palate-craniofacial J. 2003;40(3):249\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiao Y-F, Prasad N, Chiu Y-T, Yun C, Chen P-T. Cleft size at the time of palate repair in complete unilateral cleft lip and palate as an indicator of maxillary growth. Int J Oral Maxillofac Surg. 2010;39(10):956\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMeazzini MC, Giussani G, Morabito A, Semb G, Garattini G, Brusati R. A cephalometric intercenter comparison of patients with unilateral cleft lip and palate: analysis at 5 and 10 years of age and long term. Cleft palate-craniofacial J. 2008;45(6):654\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJacobson A. Tracing technique and identification of landmarks. Radiographic Cephalometry. From Basics to 3D Imaging. 4. UK: Quintessence Publishing Co. Limited, New Malden, Surrey, UK;; 2006. p. 320.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKim H-Y. Statistical notes for clinical researchers: Evaluation of measurement error 2: Dahlberg's error, Bland-Altman method, and Kappa coefficient. Restor dentistry endodontics. 2013;38(3):182\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKulewicz M, Dudkiewicz Z. Craniofacial morphological outcome following treatment with three different surgical protocols for complete unilateral cleft lip and palate: a premilinary study. Int J Oral Maxillofac Surg. 2010;39(2):122\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiao Y-F, Yang I-Y, Wang R, Yun C, Huang C-S. Two-stage palate repair with delayed hard palate closure is related to favorable maxillary growth in unilateral cleft lip and palate. Plast Reconstr Surg. 2010;125(5):1503\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGabriel da Silva Filho O, Calvano F, Alcoforado Assun\u0026ccedil;\u0026atilde;o AG, de Oliveira Cavassan A. Craniofacial morphology in children with complete unilateral cleft lip and palate: a comparison of two surgical protocols. Angle Orthod. 2001;71(4):274\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZemann W, K\u0026auml;rcher H, Drevenšek M, Koželj V. Sagittal maxillary growth in children with unilateral cleft of the lip, alveolus and palate at the age of 10 years: an intercentre comparison. J Cranio-Maxillofacial Surg. 2011;39(7):469\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBakri S, Rizell S, Lilja J, Mark H. Vertical maxillary growth after two different surgical protocols in unilateral cleft lip and palate patients. Cleft Palate-Craniofacial J. 2014;51(6):645\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiao Y-F, Mars M. Long-term effects of palate repair on craniofacial morphology in patients with unilateral cleft lip and palate. Cleft palate-craniofacial J. 2005;42(6):594\u0026ndash;600.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMommaerts MY, Kablan F, Sheth S, Laster Z. Early maxillary growth in complete cleft lip, alveolus and palate patients following Widmaier-Perko's, or a modified Furlow's technique of soft palate repair. J Cranio-Maxillofacial Surg. 2003;31(4):209\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSmahel Z, M\u0026uuml;llerov\u0026aacute; Z. Craniofacial morphology in unilateral cleft lip and palate prior to palatoplasty. Cleft palate J. 1986;23(3):225\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSadowsky C, Aduss H, Pruzansky S. The soft tissue profile in unilateral clefts. Angle Orthod. 1973;43(3):233\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNollet P, Katsaros C, Huyskens R, Borstlap W, Bronkhorst E, Kuijpers-Jagtman A. Cephalometric evaluation of long-term craniofacial development in unilateral cleft lip and palate patients treated with delayed hard palate closure. Int J Oral Maxillofac Surg. 2008;37(2):123\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cleft, palatoplasty, maxillary growth, unilateral cleft lip and palate, cephalometric analysis","lastPublishedDoi":"10.21203/rs.3.rs-6670378/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6670378/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eAim:\u003c/strong\u003e This study aimed to compare the effects of three different surgical palatal repair techniques on maxillary growth in patients with unilateral cleft lip and palate (UCLP).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods:\u003c/strong\u003eA total of 45 UCLP patients were divided into three groups, with each group receiving a different type of palatoplasty: 15 patients underwent modified Furlow palatoplasty, 15 received Sommerlad palatoplasty, and 15 underwent V-Y pushback surgery. A control group of 30 skeletal class I patients was selected. Lateral cephalograms were used for analysis. One-way ANOVA and Kruskal-Wallis tests were applied for multiple comparisons, while Tukey and Dunn tests were employed for pairwise comparisons.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The V-Y pushback group showed significantly lower S-N-A (P\u0026lt;0.05) and S-N-Ans (P\u0026lt;0.05) values, indicating reduced maxillary prominence and sagittal positioning compared to the control group. Although the modified Furlow group demonstrated higher S-N-A values, the differences were not statistically significant. Vertical dimension differences were generally insignificant across groups, except for the lower facial height-to-total facial height ratio. Significant variations were observed in soft tissue measurements. In contrast to lower dental variables, upper dental variables were significantly different among the compared groups.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003eThe findings suggest that the choice of surgical method can have significant impacts on craniofacial parameters, with the V-Y Pushback technique potentially being associated with a more retrognathic and hypoplastic maxilla. However, further research is needed to fully clarify the relative merits of the different approaches and identify the optimal treatment strategies for this complex condition.\u003c/p\u003e","manuscriptTitle":"Comparison of impact of three different methods of surgical palatal repair on maxillary growth in unilateral cleft lip and palate patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-08 06:01:48","doi":"10.21203/rs.3.rs-6670378/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-10T15:57:59+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-12T07:16:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-12T00:42:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-10T05:32:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-06T16:30:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"330747836716201429725821286373696916814","date":"2025-10-03T04:31:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"116637729987855845312559912282069242246","date":"2025-10-02T18:05:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"34129565816489583964604629533544660104","date":"2025-10-01T08:09:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-28T10:41:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"3998423159604669735485776210996763800","date":"2025-09-27T15:33:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"314645348232321436437453436823537264975","date":"2025-09-26T07:53:15+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-03T10:59:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-12T01:26:44+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-03T09:58:11+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-30T21:27:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2025-05-30T21:24:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"73e88953-f528-4b85-ae86-f0650fb89831","owner":[],"postedDate":"July 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-27T15:08:26+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-08 06:01:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6670378","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6670378","identity":"rs-6670378","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}