Craniofacial cephalometric morphologies in different cleft types: a retrospective cross-sectional study of 212 patients

Craniofacial morphological variability in orthodontic patients with non-syndromic orofacial clefts: an approach using geometric morphometrics

OBJECTIVES

Orofacial clefts are complex congenital anomalies that call for comprehensive treatment based on a thorough assessment of the anatomy. This study aims to examine the effect of cleft type on craniofacial morphology using geometric morphometrics.

MATERIALS AND METHODS

We evaluated lateral cephalograms of 75 patients with bilateral cleft lip and palate, 63 patients with unilateral cleft lip and palate, and 76 patients with isolated cleft palate. Generalized Procrustes analysis was performed on 16 hard tissue landmark coordinates. Shape variability was studied with principal component analysis. In a risk model approach, the first nine principal components (PC) were used to examine the effect of cleft type.

RESULTS

We found statistically significant differences in the mean shape between cleft types. The difference is greatest between bilateral cleft lip and palate and isolated cleft palate (distance of means 0.026, P = 0.0011). Differences between cleft types are most pronounced for PC4 and PC5 (P = 0.0001), which together account for 10% of the total shape variation. PC4 and PC5 show shape differences in the ratio of the upper to the lower face, the posterior mandibular height, and the mandibular angle.

CONCLUSIONS

Cleft type has a statistically significant but weak effect on craniofacial morphological variability in patients with non-syndromic orofacial clefts, mainly in the vertical dimension.

CLINICAL RELEVANCE

Understanding the effects of clefts on craniofacial morphology is essential to providing patients with treatment tailored to their specific needs. This study contributes to the literature particularly due to our risk model approach in lieu of a prediction model.

Does cleft lip and palate affect the severity of malocclusion?

OBJECTIVE

The purpose of this study was to evaluate the 3D anatomical features of unilateral (UCLP) and bilateral (BCLP) complete cleft lip and palate with those of skeletal Class III dentofacial deformities.

MATERIALS AND METHODS

In total, 92 patients were divided into cleft and noncleft groups. The cleft group comprised 29 patients with UCLP and 17 patients with BCLP. The noncleft group comprised 46 patients with Class III dentofacial deformities. 3D anatomical landmarks were identified and the corresponding measurements were made on the cone-beam computed tomography (CBCT).

RESULTS

The differences between the affected and unaffected sides of the patients with UCLP were nonsignificant. The differences between the patients with UCLP and BCLP were nonsignificant except for the SNA angle. Significant differences between the patients with clefts and Class III malocclusion were identified for the SNA, A-N perpendicular, and A-N Pog line, indicating that the maxillae of the patients in the cleft group were more retrognathic and micrognathic. Relative to the noncleft group patients, the cleft group patients had a significantly smaller ramus height.

CONCLUSION

The affected and unaffected sides of the patients with UCLP did not exhibit significant differences. The maxillae of the patients with UCLP were significantly more retrognathic than those of the patients with BCLP. The maxillae and mandibles of the patients in the cleft group were more micrognathic and retropositioned relative to those of the noncleft Class III patients.

CLINICAL RELEVANCE

The maxillary and mandibular findings indicated greater deficiencies in the patients with UCLP or BCLP than in those with skeletal Class III malocclusion. Appropriate surgical design should be administered.

Cephalometric Soft Tissue Morphology of Adults With Unoperated Submucous Cleft Palate

The aim of this study was to compare craniofacial soft tissue characteristics between subjects with unrepaired submucous cleft palate (SMCP) and noncleft individuals.

This retrospective cross-sectional study was performed on 27 subjects with unrepaired SMCP (13 male and 14 female subjects; mean age, 21.77 ± 4.09 years) and 30 noncleft controls (14 male and 16 female subjects; mean age, 22.67 ± 4.28 years). The predictor variable was cleft deformity. The outcome variable was cephalometric soft tissue measurements. Other study variables were gender and age. Independent samples t test and Mann-Whitney U test were used for intergroup comparison. P value was set at .05.

Significant differences were observed in the facial profile angle, total facial profile angle, soft tissue A-N-B angle, nasal base prominence, upper lip length, lower lip protrusion, and the ratio of upper lip length to mentolabial height between subjects with unoperated SMCP and noncleft controls.

The primary deformity of the cleft palate leads to unsatisfactory facial soft tissue morphology, especially in the middle facial region.

Craniofacial and three-dimensional palatal analysis in cleft lip and palate patients treated in Spain

Growth alterations have been described in patients operated on for oral clefts. The purpose of this work was to analyze the craniofacial and palate morphology and dimensions of young adults operated on for oral clefts in early childhood in Spain. Eighty-three patients from eight different hospitals were divided into four groups based on their type of cleft: cleft lip (CL, n = 6), unilateral cleft lip and palate (UCLP, n = 37), bilateral cleft lip and palate (BCLP, n = 16), and cleft palate only (CPO, n = 24). A control group was formed of 71 individuals. Three-dimensional (3D) digital models were obtained from all groups with an intraoral scanner, together with cephalometries and frontal, lateral, and submental facial photographs. Measurements were obtained and analyzed statistically. Our results showed craniofacial alterations in the BCLP, UCLP, and CPO groups with an influence on the palate, maxilla, and mandible and a direct impact on facial appearance. This effect was more severe in the BCLP group. Measurements in the CL group were similar to those in the control group. Cleft characteristics and cleft type seem to be the main determining factors of long-term craniofacial growth alterations in these patients. Prospective research is needed to clearly delineate the effects of different treatments on the craniofacial appearance of adult cleft patients.

Retrognathic maxilla in individuals born with oral clefts is due to intrinsic factors and not only due to early surgical treatment

OBJECTIVES

To determine if the skeletal form of individuals born with oral clefts was associated with maxillary position.

MATERIALS AND METHODS

Lateral cephalometric radiographs of 90 individuals 8 to 12 years old born with or without cleft lip and palate paired by age and sex were used. Skull base length, cranial base angle, cranial deflection angle, and maxillary skeletal length and position were studied. Also, mandibular skeletal length and position, lower anterior facial height, and dental position were defined. Individuals were divided into three groups: 30 individuals born with cleft lip and palate with Class III malocclusion (UCLP Class III), 30 individuals born with cleft lip and palate with Class I malocclusion (UCLP Class I), and 30 individuals born without cleft lip and palate with Class III malocclusion (non-cleft Class III).

RESULTS

When comparing the UCLP Class III group with the UCLP Class I group, there were differences in maxillary position (P < .001) and mandibular position (P = .004) found. No differences were found when comparing the UCLP Class III group with the non-cleft Class III group.

CONCLUSIONS

There are intrinsic factors that affect craniofacial morphology of individuals born with cleft lip and palate.

Cephalometric evaluation of patients with unilateral and bilateral complete cleft lip and palate

BACKGROUND

This study aimed to evaluate craniofacial cephalometric morphology in patients with unilateral clefts (UCLP) and in those with bilateral clefts (BLCP).

METHODS

The lateral radiographs of 129 patients with UCLP or BCLP referred to San Bortolo Hospital in Vicenza between January 2010 and January 2019 were retrospectively evaluated. Fourteen cephalometric hard tissue landmarks per radiographs were digitized and fifteen measurements (eight angle measurements, six linear measurements, and one ratio measurement) were calculated. Statistical analyses were carried using Chi-squared test (P<0.05).

RESULTS

The analysis included 33 patients (25%) with BCLP, 41 (32%) with right UCLP and 55 (43%) with left UCLP. Adjusting for age and sex, left UCLP was associated with lower gonial angle (mean difference [MD] -2.7, 95% CI 5.2 to -0.0), lower upper gonial angle (MD -2.2, 95% CI -3.9 to -0.6) but higher posterior facial height (MD 2.4, 95% CI 0.3 to 4.4) with respect to right UCLP. Adjusting for age and sex, BCLP was associated with lower articular angle (MD -2.8, 95% CI -5.5 to -0.2) but higher SNA (MD 2.6, 95% CI 0.6 to 4.6) and higher ANB (MD 3.2, 95% CI 1.3 to 5.0) with respect to UCLP.

CONCLUSIONS

Differences between the two groups were found in relation to three cephalometric values: articular angle, that is bigger in UCLP patients; SNA, that is bigger in BCLP patients; ANB, that is bigger in BCLP patients. This different craniofacial morphology can influence the treatment plan in cleft lip and palate patients.

Surgical maxillary advancement and speech resonance: comparison among cleft types

Purpose This study investigated the influence of the cleft type on the appearance of hypernasality after surgical maxillary advancement (MA). Methods Nasality was determined by measurement of nasalance (acoustic correlate of nasality) by nasometry. The study involved analysis of the nasalance scores of 17 individuals with isolated cleft palate (CP), 118 with unilateral cleft lip and palate (UCLP) and 69 with bilateral cleft lip and palate (BCLP), of both sexes, aged 18 to 28 years, after MA. Only individuals with normal nasalance scores indicating balanced resonance before MA were included in this study. Nasometry was performed 3 days before and 15 months after MA, on average. The proportion of patients who presented nasalance scores indicating hypernasality after surgery was calculated by the ANOVA test, and comparison among the different cleft types was evaluated by the chi-square test (p < 0.05). Results No significant difference was found in the proportions of individuals with hypernasality among the cleft types. Conclusion Nasometry showed that the appearance of hypernasality after MA in individuals with cleft palate with or without cleft lip occurred in similar proportions, regardless of the cleft type.