Individuals with unilateral cleft lip and palate (UCLP) manifest a plethora of phenotypic characteristics, including asymmetric development of the middle and lower facial skeleton. The purpose of this study was to retrospectively investigate the development of cranial base asymmetries in patients with UCLP noted on posteroanterior cephalometric radiographs.
Methods
Thirty individuals with UCLP and 64 controls participated in this study. Medial and lateral cranial base asymmetries were analyzed on frontal cephalometric radiographs relative to three developmental stages. Furthermore, the development of horizontal and vertical lower facial asymmetry in these patients with UCLP was assessed in relation to cranial base, nasomaxillary, and dentoalveolar structures.
Results
Individuals with UCLP demonstrated cranial base asymmetries that did not significantly differ from individuals without cleft. In addition, lower facial asymmetry in patients with UCLP correlated with horizontal lower facial and dentoalveolar asymmetries but not with cranial base or nasomaxillary structures.
Conclusions
No significant vertical cranial base asymmetries were detected in patients with UCLP. Horizontal lower facial asymmetry appeared to develop in close relation to the vertical asymmetries of mandibular fossae and dentoalveolus.
AthanasiouA.E.TsengC.ZarriniaK.MazaheriM.. Frontal cephalometric study of dentofacial morphology in children with bilateral clefts of lip alveolus and palate.J Craniomaxillofac Surg.1990; 18: 49–54.
2.
BisharaS.E.BurkeyP.S.KharoufJ.G.. Dental and facial asymmetries: a review.Angle Orthod.1994; 64: 89–98.
3.
DahlE.. Craniofacial morphology in congenital clefts of the lip and palate.Acta Odontol Scand.1970; 28(Suppl): 83–100.
4.
FishmanL.S.. Radiographic evaluation of skeletal maturation. A clinically oriented method based on hand–wrist films.Angle Orthod.1982; 52: 88–112.
5.
GorlinR.J.CohenM.M.LevinL.S.. Syndromes of the Head and Neck.3rd ed.New York: University Press,1990.
6.
GrummonsD.C.Kappeyne van de CoppelloM.A.. A frontal asymmetry analysis.J Clin Orthod.1987; 21: 448–465.
7.
HarrisE.. Size and form of the cranial base in isolated cleft lip and palate.Cleft Palate Craniofac J.1993; 30: 170–174.
8.
HatalaM.P.MacherD.J.TallentsR.H.SpoonM.SubtelnyJ.D.KyrkanidesS.. Effect of a surgically created disk displacement on mandibular symmetry in the growing rabbit.Oral Surg Oral Med Oral Pathol Oral Radiol Endod.1996; 82: 625–633.
9.
HelmiC.PruzanskyS.. Craniofacial and extracranial malformations in the Klippel-Feil syndrome.Cleft Palate J.1980; 17: 65–88.
IshiguroK.KrogmanW.M.. A longitudinal study of morphological craniofacial patterns via P-A X-ray headfilms in cleft patients from birth to six years of age.Cleft Palate J.1976; 13: 104–126.
12.
Kahl-NiekeB.FischbachR.. Effect of early orthopedic intervention on hemifacial microsomia patients: an approach to a cooperative evaluation of treatment results.Am J Orthod Dentofacial Orthop.1998; 114: 538–550.
13.
KodachiK.. Electromyographic study of masticatory dysfunction in patients with unilateral cleft lip and palate and reversed occlusion.Shikwa Gakuho1989; 89: 1801–1817.
14.
KyrkanidesS.BellohousenR.SubtelnyJ.D.. Asymmetries of the upper lip and nose in non-cleft and post-surgical unilateral cleft lip and palate individuals.Cleft Palate Craniofac J.1996; 33: 306–311.
15.
KyrkanidesS.BelohousenR.SubtelnyJ.D.. Skeletal asymmetries of the nasomaxillary complex in noncleft and postsurgical unilateral cleft lip and palate individuals.Cleft Palate Craniofac J.1995; 32: 428–433.
16.
LasposC.P.KyrkanidesS.TallentsR.H.MossM.E.SubtelnyJ.D.. Mandibular and maxillary asymmetry in unilateral cleft lip and palate individuals.Cleft Palate Craniofac J.1997a; 34: 232–239.
17.
LasposC.P.KyrkanidesS.TallentsR.MossM.SubtelnyJ.D.. Mandibular asymmetry in noncleft and unilateral cleft lip and palate individuals.Cleft Palate Craniofac J.1997b; 34: 410–416.
18.
LegrellP.E.IsbergA.. Mandibular height asymmetry following experimentally induced temporomandibular joint disk displacement in rabbits.Oral Surg Oral Med Oral Pathol.1998; 86: 280–285.
19.
LegrellP.E.IsbergA.. Mandibular length and midline asymmetry after experimentally induced temporomandibular joint disk displacement in rabbits.Am J Orthod Dentofacial Orthop.1999; 115: 247–253.
20.
MillerV.J.YoeliZ.BarneaE.ZeltserC.. The effect of parafunction on condylar asymmetry in patients with temporomandibular disorders.J Oral Rehabil.1998; 25: 721–724.
21.
MolstedK.DahlE.. Asymmetry of the maxilla in children with complete unilateral cleft lip and palate.Cleft Palate J.1990; 27: 184–190.
22.
MossM.. Correlation of cranial base angulation with cephalic malformations and growth disharmonies of dental interest.NY State Dent J.1955; 21: 452–454.
23.
MossM.. Malformations of the skull base associated with cleft palate deformity.Plast Reconstr Surg.1956; 17: 226–234.
24.
PoikelaA.KantomaaT.PirttiniemiP.. Craniofacial growth after a period of unilateral masticatory function in young rabbits.Eur J Oral Sci.1997; 105: 331–337.
25.
RossB.. Cranial base in children with lip and palate clefts.Cleft Palate J.1965; 2: 157–165.
26.
RyghP.SirinavinI.. Craniofacial morphology in six-year-old Norwegian boys with complete cleft of lip and palate.Swed Dent J.1982; 15(Suppl): 203–212.
27.
SandhamA.ChengL.. Cranial base and cleft lip and palate.Angle Orthod.1988; 58: 163–168.
28.
SassouniV.. Diagnosis and treatment planning via roentgenographic cephalometry.Am J Orthod.1958; 44: 433–463.
29.
SchellhasK.P.PolleiS.R.WilkesC.H.. Pediatric internal derangements of the temporomandibular joint: effect on facial development.Am J Orthod Dentofacial Orthop.1993; 104: 51–59.
30.
SilvestriA.NataliG.IannettiG.. Functional therapy in hemifacial microsomia: therapeutic protocol for growing children.J Oral Maxillofac Surg.1996; 54: 271–278.
31.
SmahelZ.BrejchaM.. Differences in craniofacial morphology between complete and incomplete unilateral cleft lip and palate in adults.Cleft Palate J.1983; 20: 113–127.
SubtelnyJ.D.. Orthodontic treatment of cleft lip and palate: birth to adulthood.Angle Orthod.1966; 36: 273–292.
34.
SubtelnyJ.D.. The degenerative, regenerative mandibular condyle: facial asymmetry.J Craniofac Genet Dev Biol.1985; 1: 227–237.
35.
VanderasA.P.RanalliD.N.. Evaluation of craniomandibular dysfunction in children 6 to 10 years of age with unilateral cleft lip of cleft lip and palate: a clinical diagnostic adjunct.Cleft Palate J.1989; 26: 337–338.
36.
WadaT.KoichiS.TachimuraT.TatsutaU.. Comparison of nasopharyngeal growth between patients with clefts and noncleft controls.Cleft Palate Craniofac J.1997; 34: 405–409.
