To evaluate the soft tissue profile and frontal photographs of 8- to 12-year-old patients with repaired complete bilateral cleft lip and palate (BCLP).
Methods:
The profile and frontal photographs obtained from 31 nonsyndromic BCLP children (aged 8-12 years: 14 boys and 17 girls) were analyzed and compared with an age- and sex-matched normal population (18 boys and 32 girls). In each patient, 12 soft tissue angular and proportional parameters on the frontal photograph and 12 angular parameters for the profile photographs were developed and measured. Student t test was used to compare the mean value of the parameters between both sexes.
Results:
In the frontal view, there was a significant difference between the 2 study groups in the facial symmetry angle (P < .001), lower facial height proportion (P < .001), upper lip proportion (P < .001), and interalar width/distance between the inner canthus of the eyes (P < .001). In the profile view, there was a significant difference between the control group and the patients with cleft lip and palate in terms of nasofrontal angle (P < .001), nasal angle (P < .001), angle of the inferior facial third (P = .032), head position angle (P < .001), facial convexity angle (P < .001), total facial convexity angle (P < .001), and vertical nasal angle (P < .001).
Conclusion:
In comparison with the normal population, the face of patients with repaired BCLP showed several soft tissue deformities, especially in the nasofrontal region, even after a surgical repair.
AlleyTRHildebrandt(-Karraker)KA. Determinants and consequences of facial aesthetics. In: AlleyTR ed. Social and Applied Aspects of Perceiving Faces. Resources for Ecological Psychology. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988:101–140.
Anicÿ-MiloševicÿSLapter-VargaMŠlajM. Analysis of the soft tissue facial profile by means of angular measurements. Eur J Orthod. 2008;30(2):135–140.
4.
BisharaSECumminsDMJorgensenGJJakobsenJR. A computer assisted photogrammetric analysis of soft tissue changes after orthodontic treatment. Part I: methodology and reliability. Am J Orthod Dentofac Orthop. 1995;107(6):633–639.
5.
BisharaSEJorgensenGJJakobsenJR. Changes in facial dimensions assessed from lateral and frontal photographs. Part I–methodology. Am J Orthod Dentofac Orthop. 1995a;108(4):389–393.
6.
BisharaSEJorgensenGJJakobsenJR. Changes in facial dimensions assessed from lateral and frontal photographs. Part II—results and conclusions. Am J Orthod Dentofac Orthop. 1995b;108(5):489–499.
7.
BisharaSEKrauseCJOlinWHWestonDNessJVFellingC. Facial and dental relationships of individuals with unoperated clefts of the lip and/or palate. Cleft Palate J. 1976;13:238–252.
8.
CorlewDS. Estimation of impact of surgical disease through economic modeling of cleft lip and palate care. World J Surg. 2010;34(3):391–396.
9.
CumminsDMBisharaSEJakobsenJR. A computer assisted photogrammetric analysis of soft tissue changes after orthodontic treatment: part II results. Am J Orthod Dentofac Orthop. 1995;108(1):38–47.
10.
De MeyAVan HoofIDe RoyGLejourM. Anatomy of the orbicularis oris muscle in cleft lip. Br J Plast Surg. 1989;42(6):710–714.
11.
DewinterGQuirynenMHeidbüchelKVerdonckAWillemsGCarelsC.Dental abnormalities, bone graft quality, and periodontal conditions in patients with unilateral cleft lip and palate at different phases of orthodontic treatment. Cleft Palate Craniofac J. 2003;40(4):343–350.
12.
FarkasLGHajnišKPosnickJC. Anthropometric and anthroposcopic findings of the nasal and facial region in cleft patients before and after primary lip and palate repair. Cleft Palate Craniofac J. 1993;30(1):1–12.
13.
FilhoLCNormandoADCDa Silva FilhoOG. Isolated influences of lip and palate surgery on facial growth: comparison of operated and unoperated male adults with UCLP. Cleft Palate Craniofac J. 1996;33(1):51–56.
14.
FujimotoTImaiKHatanoTTakahashiMTamaiM. Follow-up of unilateral cleft-lip nose deformity after secondary repair with a modified reverse-U method. J Plast Reconstr Aesthet Surg. 2011;64(6):747–753.
15.
GagglASchultesGKärcherH.Aesthetic and functional outcome of surgical and orthodontic correction of bilateral clefts of lip, palate, and alveolus. Cleft Palate Craniofac J. 1999;36(5):407–412.
16.
GarnerLD. Soft-tissue changes concurrent with orthodontic tooth movement. Am J Orthod. 1974;66(4):367–377.
17.
GuessMBSolzerWV. Computer treatment estimates in orthodontics and orthognathic surgery. J Clin Orthod. 1989;23(4):262–268.
18.
HaradaKBabaYOhyamaKOmuraK. Soft tissue profile changes of the midface in patients with cleft lip and palate following maxillary distraction osteogenesis: a preliminary study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94(6):673–677.
19.
HasanzadehNMajidiMRKianifarHEslamiN. Facial soft-tissue morphology of adolescent patients with nonsyndromic bilateral cleft lip and palate. J Craniofac Surg. 2014;25(1):314–317.
20.
HotzMMPerkoM. Early management of bilateral total cleft lip and palate. Scand J Plast Reconstr Surg. 1974;8(1-2):104–108.
21.
JahanbinAEslamiNHoseini ZarchHKobraviS. Comparative evaluation of cranial base and facial morphology of cleft lip and palate patients with normal individuals in cone beam computed tomography. J Craniofac Surg. 2015;26(3):785–788.
22.
LaurisRCMCCapelozza FilhoLCalilLRLaurisJRPJansonGGaribDG. Facial profile esthetics in operated children with bilateral cleft lip and palate. Dental Press J Orthod. 2017;22(4):41–46.
23.
LiJShiBLiuKZhengQWangYLiS. A photogrammetric study of the effects of alveolar bone graft on nose symmetry among unilateral cleft patients. J Plast Reconstr Aesthet Surg. 2011;64(11):1436–1443.
24.
LiuQYangMLLiZJBaiXFWangXKLuLWangYX. A simple and precise classification for cleft lip and palate: a five-digit numerical recording system. Cleft Palate Craniofac J. 2007;44(5):465–468.
25.
MarsMHoustonWJ. A preliminary study of facial growth and morphology in unoperated male unilateral cleft lip and palate subjects over 13 years of age. Cleft Palate J.1990;27(1):7–10.
MoslerováVDadákováMDupejJHoffmannovaEBorskýJČernýMBejdaPKočandrlováKVelemínskáJ. Three-dimensional assessment of facial asymmetry in preschool patients with orofacial clefts after neonatal cheiloplasty. Int J Pediatr Otorhinolaryngol. 2018;108:40–45.
28.
NainiFBMossJPGillDS. The enigma of facial beauty: esthetics, proportions, deformity, and controversy. Am J Orthod Dentofac Orthop. 2006;130(3):277–282.
29.
NegerM. A quantitative method for the evaluation of the soft-tissue facial profile. Am J Orthod. 1959;45(10):738–751.
30.
PaknahadMShahidiSBahrampourEBeladiASKhojastepourL. Cone beam computed tomographic evaluation of mandibular asymmetry in patients with cleft lip and palate. Cleft Palate Craniofac J. 2018;55(7):919–924.
31.
PeckHPeckS. A concept of facial esthetics. Angle Orthod. 1970;40(4):284–317.
32.
RomeroR. The Millard rotation-advancement lip repair using accurate measurements. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;84(4):335–338.
33.
RoosN. Soft-tissue profile changes in class II treatment. Am J Orthod. 1977;72(2):165–175.
34.
RottgersSALimSYHallAMZurakowskiDMullikenJB. Longitudinal photogrammetric analysis of the columellar-labial angle following primary repair of bilateral cleft lip and nasal deformity. Plast Reconstr Surg. 2017;139(5):1190–1199.
35.
SalyerKERozenSMGenecovERGenecovDG. Unilateral cleft lip—approach and technique. Semin Plast Surg. 2005;19(4):313–328.
36.
SchendelS. Unilateral cleft lip repair—state of the art. Cleft Palate Craniofac J. 2000;374(4):335–341.
37.
SivertsenÅWilcoxAJohnsonGEÅbyholmFVindenesHALieRT. Prevalence of major anatomic variations in oral clefts. Plast Reconstr Surg. 2008;121(2):587–595.
StarbuckJMGhoneimaAKulaK. Bilateral cleft lip and palate: a morphometric analysis of facial skeletal form using cone beam computed tomography. Clin Anat. 2015;28(5):584–592.
40.
StonerMM. A photometric analysis of the facial profile: a method of assessing facial change induced by orthodontic treatment. Am J Orthod. 1955;41(6):453–469.
41.
UkohaUUUdemezueOOOranusiCKAsomughaALDimkpaUNzeukwuLC. Photometric facial analysis of the Igbo Nigerian adult male. Niger Med J. 2012;53(4):240–244.
42.
UysalTSismanYKurtGRamogluSI. Condylar and ramal vertical asymmetry in unilateral and bilateral posterior crossbite patients and a normal occlusion sample. Am J Orthod Dentofac Orthop. 2009;136(1):37–43.
43.
van den DungenGMOngkosuwitoEMAartmanIHAPrahl-AndersenB. Craniofacial morphology of Dutch patients with bilateral cleft lip and palate and noncleft controls at the age of 15 years. Cleft Palate Craniofac J. 2008;45(6):661–666.
44.
WehbyGCassellCH. The impact of orofacial clefts on quality of life and health care use and costs. Oral Dis. 2010;16(1):3–10.
45.
ZaleckasLLinkevičienėLOlekasJKutraN. The comparison of different surgical techniques used for repair of complete unilateral cleft lip. Medicina (Kaunas). 2011;47(2):85–90.
