Comprehensive Smile Component Analysis in Unilateral Cleft Lip and Palate Using Akhter–Anne Framework

Abstract

Objective

This study aimed to comprehensively compare smile aesthetics between surgically corrected unilateral cleft lip and palate (CUCLP) patients and non-cleft controls, evaluating multiple facial domains to identify persistent deficits.

Design

A cross-sectional, comparative study was conducted.

Setting

The study was performed in a clinical research setting.

Patients/Participants

The cohort consisted of 30 CUCLP patients who had undergone surgical repair and 30 age- and sex-matched non-cleft controls, all aged between 16 and 30 years.

Interventions

The intervention for the patient group was prior surgical correction of CUCLP; no new intervention was administered as part of this observational study.

Main Outcome Measure(s)

Standardized frontal photographs were analyzed using MAKHTER software and the Akhter–Anne Smile Diagram. Key parameters measured across facial, nasal, labial, nasolabial, and dento-gingival domains included nasal width, commissure width, philtrum height, lip length, and incisor display.

Results

The facial component showed no significant differences. However, CUCLP patients exhibited significant deficits in other domains: reduced philtrum height (0.58 ± 0.21 mm vs. 0.84 ± 0.31 mm; p = 0.004), shorter upper lip length (0.42 ± 0.14 mm vs. 0.62 ± 0.22 mm; p = 0.001), and narrower commissure width (4.23 ± 0.52 mm vs. 6.95 ± 0.90 mm; p < 0.001). Nasal width was reduced (3.25 ± 0.40 mm vs. 4.56 ± 0.54 mm; p < 0.001) with pronounced nasolabial asymmetry. Dento-gingivally, maxillary incisor show was less (1.80 ± 0.54 mm vs. 3.45 ± 0.63 mm; p < 0.01) while mandibular incisor display was greater (2.75 ± 0.48 mm vs. 1.25 ± 0.36 mm; p < 0.05).

Conclusions

Despite surgical repair, CUCLP patients have persistent esthetic impairments, particularly in the nasolabial and dento-gingival regions. A structured, multi-domain smile analysis is crucial for guiding multidisciplinary treatment to optimize final aesthetic and psychosocial outcomes.