The shape and size of the alveolar arch are sometimes considerably affected as an after result of uranoplasty. It would appear that in the young the contraction of the cicatrix between the palatal segments and of the new tissue in the lateral openings exercises a narrowing influence on the transverse diameter. The alveolar borders approach one another, and this approximation is most marked at the level of the first or second bicuspids, and indeed is so great occasionally as to produce an obvious incurvation of the alveolar ridge. M. Ehrmann of Paris, has investigated many instances of this change, and from his work[102] the figures mentioned below are obtained.
In one case a child was operated on for total cleft at three and a half years. Six months later the following measurements were taken:
| Transverse interval between | canines | 13 mms. |
| ” ” | 1st molars | 18 ” |
| ” ” | 2nd ” | 26 ” |
At twenty-three years of age the following were the measurements:
| Transverse interval between | canines | 7 mms. |
| ” ” | 1st premolars | 13 ” |
| ” ” | 2nd ” | 19 ” |
| ” ” | 1st molars | 23 ” |
| ” ” | 2nd ” | 32 ” |
The alveoli here formed a reversed 𝖵, and when the patient spoke, the tongue was more or less protruded. In another case, operated on at five years of age for the palate defect, a double harelip having been treated at an earlier date, the measurements were—
| At 5 years. | At 6 years. | At 11 years. | ||
|---|---|---|---|---|
| Intervals between | canines | 23 mms. | 19 mms. | 12 mms. |
| ” | 1st premolars | 27 ” | 24 ” | 14 ” |
| ” | 2nd ” | 32 ” | 27 ” | 19 ” |
| ” | 1st molars | — | — | 23 ” |
This result is more frequently seen in the severer forms of cleft palate associated with double harelip, especially where the os incisivum has been removed. Extreme youth increases the tendency to the production of these deformities, which may become troublesome, not only by interfering with the size of the buccal cavity, and so causing protrusion of the tongue during speech, but also by interfering with the “bite,” necessitating lateral movement of the jaw during mastication.
In one of Ehrmann’s cases an actual increase of the interdental diameters was found; this was one in which Fergusson’s osteoplasty had been performed with complete success; possibly the formation of new bone from the callus produced led to this, or it may have been merely an evidence of normal growth. The measurements were as follows: