CLASSIFICATION OF COMPLEX ANATOMICAL VARIANTS IN PEDIATRIC PATIENTS AFTER URANOPLASTY: AN INTEGRATED DIGITAL AND BIOCHEMICAL MONITORING APPROACH

Abstract

Background: Cleft palate (CP) remains one of the most prevalent congenital craniofacial anomalies globally, affecting approximately 1 in 700 live births. Although uranoplasty restores anatomical continuity of the palate, post-surgical rehabilitation is frequently complicated by residual neuromuscular imbalances, altered occlusal dynamics, and compromised mucosal immune function. The absence of an integrated, multimodal monitoring framework limits the clinician's ability to detect and address these sequelae in a timely manner. Objective: This study aimed to develop and validate an integrated classification of complex anatomical variants observed in post-uranoplasty pediatric patients, and to evaluate the effectiveness of digital monitoring combined with biopolymer aligner-based orthodontic therapy on neuromuscular, occlusal, and biochemical outcomes. Methods: A prospective clinical observational study enrolled 150 children aged 6–12 years, divided into three groups of 50: a main group receiving digital monitoring with electromyography (EMG), T-Scan occlusal analysis, and biopolymer aligner therapy; a comparison group receiving conventional orthodontic treatment; and a healthy control group. Salivary biomarkers—alpha-amylase and secretory immunoglobulin A (sIgA)—were quantified at baseline and after 12 months. Statistical analysis employed the Mann–Whitney U test, Wilcoxon signed-rank test, and Spearman correlation (significance: p<0.05). Results: At baseline, masseter peak amplitude in the main group was 118.4 ± 12.3 μV, representing a 2.1-fold reduction versus controls (247.3 ± 18.6 μV; p<0.001). Muscular asymmetry index reached 31.4 ± 3.4%. Total occlusion time was prolonged approximately fourfold (1.82 ± 0.21 s vs. 0.46 ± 0.06 s in controls; p<0.001). Salivary alpha-amylase was elevated 2.2-fold relative to healthy peers. After 12 months, the main group demonstrated statistically superior improvements in all parameters compared to the comparison group (p<0.05 for all outcomes). Conclusion: Integrated digital monitoring combining EMG, T-Scan, and salivary biomarkers enables a precise, evidence-based classification of post-uranoplasty anatomical variants and substantially enhances rehabilitation outcomes. Early multimodal intervention is recommended for all pediatric patients following cleft palate repair.