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Dindaroglu F, Dogan E, Dogan S. Is the Nasolabial Region Symmetric in Individuals With Cleft Lip and Palate? Cleft Palate Craniofac J 2024; 61:12-19. [PMID: 35912442 DOI: 10.1177/10556656221116535] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the nasolabial symmetry in smile and resting position in individuals with nonsyndromic unilateral cleft lip and palate (UCLP) and compare with Class I individuals without cleft lip and palate (CLP). MATERIALS AND METHODS Frontal photographs of 40 individuals with UCLP (mean age 14.30 ± 0.25 years; 20 female, 20 male) and 40 skeletal Class I individuals without CLP (mean age 14.60 ± 0.34 years; 20 female and 20 male) were examined. Bland-Altman Levels of Agreements, Mann-Whitney U test, independent sample t-test were conducted, and intraclass correlation coefficients (ICCs) were calculated for statistical analysis. RESULTS Differences in the transverse lip distance (d-d') and vertical lip height at crista philtri (e-e') were lesser in the UCLP group at smile (P = .001; P = .005, respectively). When comparing the differences in these measurements at rest between control and UCLP groups, vertical lip height was longer at crista philtri (e-e') (P = .014), crista philtri was more laterally located (f-f') (P = .002), and the transverse lip distance was greater (d-d') (P = .004) in the UCLP group. Distance of the crista philtri to the midline of the face (f-f') (P = .007) were higher in the UCLP group during smiling compared to control group. CONCLUSIONS Nasolabial region asymmetry in smiling and rest position in individuals with UCLP was significantly different from the control group. However, the asymmetry in the nasolabial region, which is more evident in the resting position in individuals with UCLP, decreases during smiling.
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Affiliation(s)
- Furkan Dindaroglu
- Department of Orthodontics, Faculty of Dentistry, Ege University, Izmir, Turkey
| | - Ege Dogan
- Department of Orthodontics, Faculty of Dentistry, Ege University, Izmir, Turkey
| | - Servet Dogan
- Department of Orthodontics, Faculty of Dentistry, Ege University, Izmir, Turkey
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A Comparative Assessment of Nasal Appearance following Nasoalveolar Molding and Primary Surgical Repair for Treatment of Unilateral Cleft Lip and Palate. Plast Reconstr Surg 2021; 148:1075-1084. [PMID: 34546190 DOI: 10.1097/prs.0000000000008462] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Although many cleft teams have adopted nasoalveolar molding to improve nasal form, few comparative studies have assessed the postoperative benefits of this treatment. Given that reported outcomes have been contradictory and that treatment involves considerable burden to families, the purpose of this study was to assess objective and subjective changes from nasoalveolar molding at approximately 5 years of age. METHODS All patients with complete unilateral cleft lip and palate who underwent primary cheiloplasty performed by a single surgeon over a 7-year period were reviewed. Patient results were grouped into nasoalveolar molding or no-nasoalveolar molding. Cleft severity and aesthetic outcomes were assessed by panels of raters who independently ranked subject images at presentation, immediately preoperative (after molding), and at 5-year follow-up. Objective symmetry was measured using standard anthropometric analysis on three-dimensional images. RESULTS Among 41 patients included, 16 successfully completed nasoalveolar molding. Both groups were similar at presentation; however, the nasoalveolar molding group had improved appearance following molding (p < 0.05). After surgery, at 5 years of age, the nasoalveolar molding group had better rank scores for overall appearance (p < 0.05), cleft nostril height, and cleft medial lip height (p < 0.05). Regression analysis revealed that nasoalveolar molding treatment was the most significant predictor of overall nasal appearance at 5 years, but that treatment team experience and initial severity were also significant predictors (p < 0.05). Qualitative audit following analysis identified favorable and unfavorable features of nasoalveolar molding. CONCLUSION In children with complete unilateral cleft lip and palate, nasoalveolar molding was associated with better overall nasal aesthetics and improved cleft nostril height and cleft medial lip height at approximately 5 years of age. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Jing J, Chen X, Shi B, Wang Y, Mou Y, Lu Y. Preoperative analysis of upper lip in patients with upper cleft lip/palate before lip repair. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:698. [PMID: 33987396 PMCID: PMC8106071 DOI: 10.21037/atm-21-1424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The postoperative morphological appearances vary widely patients with unilateral cleft lip with or without cleft palate (UCL/P), whether it is complete or incomplete cleft. The main reason of bilateral lip asymmetry after cleft lip surgery lies in the lack of personalized measurement and design before surgery. In this study, we aim to individually investigate areas of the upper lip on cleft and non-cleft sides in patients with unilateral cleft lip with or without cleft palate (UCL/P). Methods Ninety-two patients with UCL/P (group 1: <1 year, group 2: 1–2 years) were included in the study. Group 1 included 37 patients with incomplete UCL/P and 29 with complete UCL/P; group 2 included 11 and 15 patients, respectively. The total area of the upper lip on the cleft side (Q8) was divided into Q3, Q4, and Q5 (further divided into a1 and a2), and the upper lip on the non-cleft side (Q7) was divided into Q2 and Q1 (further divided into A1 and A2). Area ratios between the cleft and the non-cleft sides were calculated, and certain parameters were tested for correlations with these ratios. Results Values of Q8/Q7 were partially overlapped between patients with complete and incomplete UCL/P. Significant correlations were noted between differences in height of the philtrum column (a–h) and the prolabial area ratio between the cleft and the non-cleft side (Q3/Q2) (P=0.032). Moreover, a significant correlation was noted between a1/A1 and the ratio of the lateral labial area between the cleft and the non-cleft side (Q5/Q1) (P=0.001). Conclusions The conventional classification of unilateral cleft lip as incomplete and complete does not completely and accurately reflect individual malformations. Therefore, it is necessary to analyze unilateral cleft lips individually to determine the repair technique and to predict postoperative outcomes.
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Affiliation(s)
- Junyan Jing
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiaoxuan Chen
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Bing Shi
- Department of Cleft Lip and Palate Surgery, West China College of Stomatology, Sichuan University, Chengdu, China
| | - Yufeng Wang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yongbin Mou
- Department of Oral Implantology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yong Lu
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
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Tangco I, Bhandari K, Yao CF, Liu AWC, Chen PKT, Lu TC. Unilateral Cleft Lip Repair Using the Chang Gung Technique: An Outcome Analysis. Ann Plast Surg 2021; 86:S41-S45. [PMID: 33438954 DOI: 10.1097/sap.0000000000002704] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This retrospective study analyzed the outcomes of patients undergoing complete or incomplete unilateral cleft lip repair using the Chang Gung technique. The goal was to compare the symmetry and change of the technique through the measurement of anthropometric points on digital photographs. METHODS From 2010 to 2016, a total of 274 complete and incomplete cleft lip patients without other craniofacial deformities were included in the study. All included patients had a minimum 1-year follow-up with frontal view photographs taken. The vermilion area, lip width, vermilion height, lateral lip length, lip height, and Cupid's bow width of both cleft and noncleft sides were measured for all patients. The Cleft Lip Component Symmetry Index was used to determine the symmetry of the cleft and noncleft sides in both incomplete and complete cleft groups. RESULTS A total of 152 complete and 122 incomplete cleft lip patients were included in the study. The mean Cleft Lip Component Symmetry Index values showed that the vermilion area, lip height, and Cupid's bow width were symmetric on both cleft and noncleft sides. Lip width and lateral lip length were noted to be shorter, whereas the vermilion height was thicker on the cleft side than on the noncleft side. Significant differences between the complete and incomplete cleft group measurements were found for lateral lip length and lip height, and complete cleft measurements were shorter than those for incomplete clefts. There were no significant differences in vermilion area, lip width, vermilion height, and Cupid's bow width. CONCLUSIONS The outcome analysis showed that vermilion height reduction and modifications could be made for both complete and incomplete groups. The complete cleft lip has been found to have a significantly shorter lateral lip length and lip height, reflecting a more severe anatomical soft tissue deficiency in this group. A long-term outcome anthropometric point study may further verify the results of this surgical technique.
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Affiliation(s)
| | | | - Chuan-Fong Yao
- Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | | | - Philip Kuo-Ting Chen
- Department of Plastic and Reconstructive Surgery, Taipei Medical University Hospital, Taipei, Taiwan
| | - Ting-Chen Lu
- Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
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Kuijpers MAR, Maal TJJ, Meulstee JW, Carels CEL, Bronkhorst EM, Bergé SJ, Fudalej PS. Nasolabial shape and aesthetics in unilateral cleft lip and palate: an analysis of nasolabial shape using a mean 3D facial template. Int J Oral Maxillofac Surg 2020; 50:267-272. [PMID: 32605823 DOI: 10.1016/j.ijom.2020.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/02/2020] [Accepted: 06/04/2020] [Indexed: 11/18/2022]
Abstract
The aim of this study was to determine the amount of deviation in nasolabial shape in patients with a cleft compared with an average non-cleft face, and to assess whether this difference is related to nasolabial aesthetics. Three-dimensional stereophotogrammetric images of 60 patients with a unilateral cleft were used. To quantify shape differences, four average non-cleft faces were constructed from stereophotogrammetric images of 141 girls and 60 boys. Three-dimensional shape differences were calculated between superimposed cleft faces and the average non-cleft face for the same sex and age group. Nasolabial aesthetics were rated with the modified Asher-McDade Aesthetic Index using a visual analogue scale (VAS). Mean VAS scores ranged from 51.44 to 60.21 for clefts, with lower aesthetic ratings associated with increasing cleft severity. Shape differences were found between cleft faces and the average non-cleft face. No relationship was found for the VAS, age, and sex, except that a lower VAS was related to a higher nose and lip distance between the superimposed cleft and average non-cleft faces for nasal profile (P= 0.02), but the explained variance was low (R2=0.066). In conclusion, except for nasal profile, nasolabial aesthetics were not influenced by the extent of shape differences from the average non-cleft face.
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Affiliation(s)
- M A R Kuijpers
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands; Cleft Palate Craniofacial Unit, Radboud University Medical Center, Nijmegen, The Netherlands
| | - T J J Maal
- Radboudumc 3D Lab, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J W Meulstee
- Radboudumc 3D Lab, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - C E L Carels
- Department of Oral Health Sciences, KU Leuven and University Hospitals KU Leuven, Leuven, Belgium
| | - E M Bronkhorst
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Dentistry, Section of Cariology and Endodontology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S J Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - P S Fudalej
- Department of Orthodontics and Dentofacial Orthopaedics, University of Bern, Bern, Switzerland; Department of Orthodontics, Palacký University, Olomouc, Czech Republic; Department of Orthodontics, Institute of Dentistry, Jagiellonian University, Krakow, Poland.
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The Effect of Autologous Alveolar Bone Grafting on Nasolabial Asymmetry in Unilateral Cleft Lip and Palate. J Craniofac Surg 2020; 31:1687-1691. [PMID: 32282667 DOI: 10.1097/scs.0000000000006393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The objective of this study was to examine whether an autologous alveolar bone graft has an effect on the nasolabial asymmetry in unilateral cleft lip, alveolus, and palate. Fifteen children (mean age 7.5 ± 2.4 years) with non-syndromic unilateral cleft lip and palate (CLP) were included. Non-ionizing three-dimensional images were acquired prior to and three months after the alveolar bone grafting procedure. A 2D and a landmark-independent 3D asymmetry assessment were used to detect changes of asymmetry in the nasolabial area. For the 2D assessment, a cleft and non-cleft side ratio for 4 linear nasal and 2 linear labial distances was expressed as a Coefficient of Asymmetry (CA). The 3D asymmetry assessment comprised a robust superimposition of the face with its mirror image, expressed as a root-mean-square-error (RSME) in mm. A significant decrease in the CA for the labial distance from the facial midline to the labial commissure was observed (P = 0.036). Also, the CA for the labial distance from the facial midline to the highest point of Cupid's bow increased significantly (P = 0.028). Non-significant changes were observed for the CA for the 2 nasal distances and the 2 other labial distances. No significant changes in 3D nasal asymmetry were detected (P = 0.820). Alveolar bone grafting completes the alveolar ridge but has only little to no clinical effect on the asymmetry of the secondary cleft lip nasal deformity.
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Montes ABM, Oliveira TM, Gavião MBD, Barbosa TDS. Orofacial functions and quality of life in children with unilateral cleft lip and palate. Braz Oral Res 2019; 33:e0061. [PMID: 31531563 DOI: 10.1590/1807-3107bor-2019.vol33.0061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 05/14/2019] [Indexed: 01/24/2023] Open
Abstract
This study aimed to evaluate the orofacial functions and oral health-related quality of life (OHRQoL) of children with unilateral cleft lip and palate (UCLP). This case-control study included patients with UCLP matched by sex and age with controls (children without UCLP), resulting in the inclusion of a total of 108 eight- to ten-year-old children. Orofacial functions and OHRQoL were evaluated using the Nordic Orofacial Test-Screening (NOT-S) and the Child Perceptions Questionnaire (CPQ 8-1 0 ), respectively. Data normality was assessed by the Kolmogorov-Smirnov test. Differences and correlations in NOT-S and CPQ 8-1 0 scores between and within the groups were evaluated using Mann-Whitney and Spearman´s correlation tests, respectively. The distribution of NOT-S and global ratings of CPQ 8-1 0 for each group were assessed by Chi-squared/Fisher's Exact tests. The UCLP group had a higher NOT-S total and examination scores than the controls. Dysfunctions related to breathing, facial symmetry/expression, and speech were more frequent in the UCLP patients than in the controls. The UCLP group had higher scores on the social well-being domain than the controls. There was a significant difference between the groups in their ratings in regards to the extent to which their oral condition affected their life overall, with controls perceiving it as somewhat better than patients. In both groups, NOT-S total and interview scores were positively correlated with CPQ 8-1 0 total and domain scores. The NOT-S examination score was only significantly correlated with social domain scores in the control group. The presence of UCLP was associated with clinical signs of orofacial dysfunctions related to breathing, facial symmetry/expression, and speech. Children with UCLP reported more orofacial dysfunctions and negative impacts on social well-being than controls.
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Affiliation(s)
- Ana Bheatriz Marangoni Montes
- Universidade Estadual de Campinas - Unicamp, Piracicaba Dental School , Department of Pediatric Dentistry , Piracicaba , SP , Brazil
| | - Thais Marchini Oliveira
- Universidade de São Paulo - USP, Bauru School of Odontology , Department of Pediatric Dentistry , Bauru , SP , Brasil
| | - Maria Beatriz Duarte Gavião
- Universidade Estadual de Campinas - Unicamp, Piracicaba Dental School , Department of Pediatric Dentistry , Piracicaba , SP , Brazil
| | - Taís de Souza Barbosa
- Universidade Federal de Juiz de Fora - UFJF, Department of Dentistry , Governador Valadares , MG , Brazil
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9
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Functional stability analyses of maxillofacial skeleton bearing cleft deformities. Sci Rep 2019; 9:4261. [PMID: 30862870 PMCID: PMC6414651 DOI: 10.1038/s41598-019-40478-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 01/29/2019] [Indexed: 02/05/2023] Open
Abstract
The symmetrically stable craniofacial bony structure supports the complex functions and delicate contour of the face. Congenital craniofacial deformities are often accompanied by bony defects and have been repetitively correlated with compromised dento-maxillary stability, but neither the extent nor the pattern of cleft-related maxillary instability has been explored in detail. Furthermore, it is largely unknown if the bony defect and related instability are correlated with secondary maxillary deformity common among patients with orofacial clefts. With the aid of finite element modeling, we studied the detailed relationship between cleft-related bony defect and maxillary stability under occlusal loading. Craniofacial models were generated based on cone-beam computed tomography data and loaded with mimicked bite forces along the axial axis of each tooth. Our data showed that all cleft models exhibited more asymmetrical deformations under mastication compared with the normal. Models with palatal cleft demonstrated greater asymmetry, greater dental arch contraction, and less maxillary protrusion compared to models with alveolar cleft only. For unilateral cleft models, alveolus on non-cleft side tended to be more protruded and lifted than the cleft side. For bilateral cleft models, the most prominent feature was the seriously contracted alveolar arch and curved and pitched premaxillae. These findings indicated cleft type-specific pattern of maxillary instability, which were largely in accordance with dentoalveolar morphological features among patients. Collectively, our study elucidated the detailed relationship between cleft bony defect and the pattern of maxillary instability, and suggested a prototype for studying the abnormal maxillary and dental arch growth among patients with craniofacial deformities.
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Nguyen VT, Nguyen T, Jagomägi T. Nasolabial aesthetics of patients with repaired unilateral cleft lip and palate: A comparison of three rating methods in two countries. J Craniomaxillofac Surg 2018; 46:1385-1389. [PMID: 29861405 DOI: 10.1016/j.jcms.2018.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 04/20/2018] [Accepted: 05/11/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES The study aimed to compare nasolabial aesthetics of patients with unilateral cleft lip and palate (UCLP) treated in Vietnam and Estonia using three rating methods: five-point aesthetic index, a visual analogue scale (VAS), and reference scores method. METHODS A total of 56 patients with repaired UCLP (23 from Vietnam and 33 from Estonia) were included in this cross-sectional study. Patients' facial and profile photographs were cropped to reveal the nasolabial region and coded. Five examiners rated nasolabial aesthetics of the patients using three methods: five-point aesthetic index, 100 mm VAS, and reference scores method. Intraclass correlation coefficients were used to evaluate intrarater and interrater reliabilities. RESULTS The five-point aesthetic index had a higher reliability than VAS and reference scores method. The least aesthetic feature among Vietnamese and Estonian patients was nasal symmetry and nasolabial profile respectively. No differences in nasolabial aesthetics were found between Vietnamese and Estonian patients regardless of the rating methods (p > 0.05) except for nasal symmetry. CONCLUSIONS The five-point aesthetic index seems to produce more reproducible results. There were no significant differences in nasolabial aesthetics between the two countries. Overall average nasolabial appearance results were obtained using different treatment protocols in the two countries.
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Affiliation(s)
- Van Thai Nguyen
- Institute of Dentistry, University of Tartu, Raekoja Plats 6, Tartu, 51003, Estonia; Faculty of Odonto-Stomatology, Hue University of Medicine and Pharmacy, 6 Ngo Quyen, Hue, Viet Nam.
| | - Toai Nguyen
- Faculty of Odonto-Stomatology, Hue University of Medicine and Pharmacy, 6 Ngo Quyen, Hue, Viet Nam
| | - Triin Jagomägi
- Institute of Dentistry, University of Tartu, Raekoja Plats 6, Tartu, 51003, Estonia
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Mercan E, Morrison CS, Stuhaug E, Shapiro LG, Tse RW. Novel computer vision analysis of nasal shape in children with unilateral cleft lip. J Craniomaxillofac Surg 2017; 46:35-43. [PMID: 29174554 DOI: 10.1016/j.jcms.2017.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 10/19/2017] [Accepted: 10/20/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Optimization of treatment of the unilateral cleft lip nasal deformity (uCLND) is hampered by lack of objective means to assess initial severity and changes produced by treatment and growth. The purpose of this study was to develop automated 3D image analysis specific to the uCLND; assess the correlation of these measures to esthetic appraisal; measure changes that occur with treatment and differences amongst cleft types. METHODS Dorsum Deviation, Tip-Alar Volume Ratio, Alar-Cheek Definition, and Columellar Angle were assessed using computer-vision techniques. Subjects included infants before and after primary cleft lip repair (N = 50) and children aged 8-10 years with previous cleft lip (N = 50). Two expert surgeons ranked subjects according to esthetic nose appearance. RESULTS Computer-based measurements strongly correlated with rankings of infants pre-repair (r = 0.8, 0.75, 0.41 and 0.54 for Dorsum Deviation, Tip-Alar Volume Ratio, Alar-Cheek Definition, and Columellar Angle, p < 0.01) while all measurements except Alar-Cheek Definition correlated moderately with rankings of older children post-repair (r ∼ 0.35, p < 0.01). Measurements were worse with greater severity of cleft type but improved following initial repair. Abnormal Dorsum Deviation and Columellar Angle persisted after surgery and were more severe with greater cleft type. CONCLUSIONS Four fully-automated measures were developed that are clinically relevant, agree with expert evaluations and can be followed through initial surgery and in older children. Computer vision analysis techniques can quantify the nasal deformity at different stages, offering efficient and standardized tools for large studies and data-driven conclusions.
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Affiliation(s)
- Ezgi Mercan
- University of Washington, Paul G. Allen School of Computer Science (Director: Henry M. Levy), AC101 Paul G. Allen Center for Computer Science & Engineering, 185 Stevens Way, Seattle, WA 98195, USA.
| | - Clinton S Morrison
- Cleft and Craniofacial Center, Golisano Children's Hospital (Chief, Plastic Surgery: Howard Langstein, M.D.), University of Rochester Medical Center, School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Erik Stuhaug
- Division of Craniofacial and Plastic Surgery, Seattle Children's Hospital (Surgical Director: Richard A. Hopper, M.D., M.S.), 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Linda G Shapiro
- University of Washington, Paul G. Allen School of Computer Science (Director: Henry M. Levy), AC101 Paul G. Allen Center for Computer Science & Engineering, 185 Stevens Way, Seattle, WA 98195, USA
| | - Raymond W Tse
- Division of Craniofacial and Plastic Surgery, Seattle Children's Hospital (Surgical Director: Richard A. Hopper, M.D., M.S.), 4800 Sand Point Way NE, Seattle, WA 98105, USA
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Mbuyi-Musanzayi S, Tshilombo Katombe F, Lukusa Tshilobo P, Kalenga Mwenze Kayamba P, Devriendt K, Reychler H. Anthropometric and aesthetic outcomes for the nasolabial region in 101 consecutive African children with unilateral cleft lip one year after repair using the anatomical subunit approximation technique. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Pietruski P, Majak M, Debski T, Antoszewski B. A novel computer system for the evaluation of nasolabial morphology, symmetry and aesthetics after cleft lip and palate treatment. Part 1: General concept and validation. J Craniomaxillofac Surg 2017; 45:491-504. [PMID: 28238558 DOI: 10.1016/j.jcms.2017.01.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 12/19/2016] [Accepted: 01/24/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The need for a widely accepted method suitable for a multicentre quantitative evaluation of facial aesthetics after surgical treatment of cleft lip and palate (CLP) has been emphasized for years. The aim of this study was to validate a novel computer system 'Analyse It Doc' (A.I.D.) as a tool for objective anthropometric analysis of the nasolabial region. MATERIALS AND METHODS An indirect anthropometric analysis of facial photographs was conducted with the A.I.D. system and Adobe Photoshop/ImageJ software. Intra-rater and inter-rater reliability and the time required for the analysis were estimated separately for each method and compared. RESULTS Analysis with A.I.D. system was nearly 10-fold faster than that with the reference evaluation method. The A.I.D. system provided strong inter-rater and intra-rater correlations for linear, angular and area measurements of the nasolabial region, as well as a significantly higher accuracy and reproducibility of angular measurements in submental view. No statistically significant inter-method differences were found for other measurements. CONCLUSIONS The hereby presented novel computer system is suitable for simple, time-efficient and reliable multicenter photogrammetric analyses of the nasolabial region in CLP patients and healthy subjects.
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Affiliation(s)
- Piotr Pietruski
- Department of Plastic and Reconstructive Surgery, Centre of Postgraduate Medical Education, Prof. W. Orlowski Memorial Hospital, Warsaw, Poland.
| | - Marcin Majak
- Department of Systems and Computer Networks, Faculty of Electronics, Wroclaw University of Science and Technology, Wroclaw, Poland
| | - Tomasz Debski
- Department of Plastic and Reconstructive Surgery, Centre of Postgraduate Medical Education, Prof. W. Orlowski Memorial Hospital, Warsaw, Poland
| | - Boguslaw Antoszewski
- Department of Plastic, Reconstructive and Aesthetic Surgery, Norbert Barlicki Memorial Hospital, Lodz, Poland
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Adeola AO, Oladimeji AA. Developing a visual rating chart for the esthetic outcome of unilateral cleft lip and palate repair. Ann Maxillofac Surg 2015; 5:55-61. [PMID: 26389035 PMCID: PMC4555950 DOI: 10.4103/2231-0746.161060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Aesthetic impairment is a major concern for the cleft lip/palate patient. Thus, auditing of postsurgical esthetic outcome needs to be further explored as till date no universally accepted protocol exists. The study objective was to propose a new visual rating chart (VRC) for the aesthetic outcome of cleft lip and palate (CLP) surgery. MATERIALS AND METHODS In a retrospective review of 200 repaired clefts, the common esthetic deficiencies were identified, categorized and ranked in the order of severity. A chart of the illustrative diagram with textual description of the defects was produced and used as a basis for rating outcome by two groups of raters (familiar raters and recruited raters). Intra- and inter-raters reliability was estimated using Cohen's kappa statistics and intra-class correlation coefficient (ICC). Comparison between mean group coefficient was achieved with Kendall's correlation coefficient of concordance. RESULTS The intra- and inter-rater reliability for familiar raters was found to be strong with kappa values range of 0.80-0.87 (P < 0.001). Similarly, inter-raters' reliability by recruited judges was very strong using ICC at both single (0.768) and average measures (0.982). CONCLUSION The VRC is a reliable tool for assessing the esthetic outcome of CLP repairs.
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Affiliation(s)
- A Olusanya Adeola
- Department of Oral and Maxillofacial Surgery, University College Hospital, Ibadan, Oyo State, Nigeria
| | - A Akadiri Oladimeji
- Faculty of Dentistry, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
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Desmedt DJ, Maal TJ, Kuijpers MA, Bronkhorst EM, Kuijpers-Jagtman AM, Fudalej PS. Nasolabial symmetry and esthetics in cleft lip and palate: analysis of 3D facial images. Clin Oral Investig 2015; 19:1833-42. [PMID: 25802221 DOI: 10.1007/s00784-015-1445-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To determine the relationship between nasolabial symmetry and esthetics in subjects with orofacial clefts. MATERIAL AND METHODS Eighty-four subjects (mean age 10 years, standard deviation 1.5) with various types of nonsyndromic clefts were included: 11 had unilateral cleft lip (UCL); 30 had unilateral cleft lip and alveolus (UCLA); and 43 had unilateral cleft lip, alveolus, and palate (UCLAP). A 3D stereophotogrammetric image of the face was taken for each subject. Symmetry and esthetics were evaluated on cropped 3D facial images. The degree of asymmetry of the nasolabial area was calculated based on all 3D data points using a surface registration algorithm. Esthetic ratings of various elements of nasal morphology were performed by eight lay raters on a 100 mm visual analog scale. Statistical analysis included ANOVA tests and regression models. RESULTS Nasolabial asymmetry increased with growing severity of the cleft (p = 0.029). Overall, nasolabial appearance was affected by nasolabial asymmetry; subjects with more nasolabial asymmetry were judged as having a less esthetically pleasing nasolabial area (p < 0.001). However, the relationship between nasolabial symmetry and esthetics was relatively weak in subjects with UCLAP, in whom only vermilion border esthetics was associated with asymmetry. CONCLUSIONS Nasolabial symmetry assessed with 3D facial imaging can be used as an objective measure of treatment outcome in subjects with less severe cleft deformity. In subjects with more severe cleft types, other factors may play a decisive role. CLINICAL SIGNIFICANCE Assessment of nasolabial symmetry is a useful measure of treatment success in less severe cleft types.
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Affiliation(s)
- Dries J Desmedt
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thomas J Maal
- Department of Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mette A Kuijpers
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, The Netherlands.,Cleft Palate Craniofacial Unit, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ewald M Bronkhorst
- Department of Preventive and Curative Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anne Marie Kuijpers-Jagtman
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, The Netherlands.,Cleft Palate Craniofacial Unit, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Piotr S Fudalej
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland. .,Department of Orthodontics, Palacky University Olomouc, Olomouc, Czech Republic.
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Late Cutaneous Lip Height in Unilateral Incomplete Cleft Lip Patients Does Not Differ From the Normative Data. J Craniofac Surg 2014; 25:308-13. [PMID: 24406595 DOI: 10.1097/scs.0000000000000521] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Eichenberger M, Staudt CB, Pandis N, Gnoinski W, Eliades T. Facial attractiveness of patients with unilateral cleft lip and palate and of controls assessed by laypersons and professionals. Eur J Orthod 2013; 36:284-9. [PMID: 23832974 DOI: 10.1093/ejo/cjt047] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The aim of the study was to identify differences in the aesthetic evaluation of profile and frontal photographs of (1) patients treated for complete left-sided cleft lip and palate and (2) control patients by laypeople and professionals. MATERIALS, SUBJECTS, AND METHODS Left-side profile and frontal photographs of 20 adult patients treated for complete left-sided cleft lip and palate (10 men, 10 women, mean age: 20.5 years) and of 10 control patients with a class I occlusion (five men, five women, mean age: 22.1 years) were included in the study. The post-treatment photographs were evaluated by 15 adult laypeople, 14 orthodontists, and 10 maxillofacial surgeons. Each photograph was judged on a modified visual analogue scale (VA S, 0-10; 0 'very unattractive' to 10 'very attractive'). A four-level mixed model was fitted in which the VA S score was the dependent variable; cases, profession, view, and rater were independent variables. RESULTS Compared with laypersons, orthodontists gave higher VA S scores (+0.69, 95% confidence interval (CI) [0.53, 0.84]; P < 0.001), followed by surgeons (+0.21, 95% CI [0.03, 0.38], P = 0.02). Controls were given significantly higher scores than patients with clefts for profile and frontal photographs (+1.97, 95% CI [1.60; 2.35], P < 0.001). No significant difference was found between the scores for the frontal and lateral views (P = 0.46). CONCLUSIONS All the different rater panels were less satisfied with the facial aesthetics of patients with clefts compared with that of control patients. Further research should evaluate whether these findings correlate with patients' self-perception and to what extent it affects the patients' psychosocial well-being.
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Affiliation(s)
- Martina Eichenberger
- * Department for Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Switzerland and
| | - Christine B Staudt
- * Department for Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Switzerland and
| | - Nikolaos Pandis
- ** Department of Orthodontics and Dentofacial Orthopedics, Dental School, University of Bern, Switzerland
| | - Wanda Gnoinski
- * Department for Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Switzerland and
| | - Theodore Eliades
- * Department for Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Switzerland and
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Freeman AK, Mercer NSG, Roberts LM. Nasal asymmetry in unilateral cleft lip and palate. J Plast Reconstr Aesthet Surg 2013; 66:506-12. [PMID: 23352885 DOI: 10.1016/j.bjps.2012.12.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 10/19/2012] [Accepted: 12/06/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Comparison of nasal asymmetry between unilateral cleft lip and palate (UCLP) patients with and without nasal correction at primary repair. Assessment of the value of Symnose as a routine research tool. PARTICIPANTS 75 ten-year-old UCLP patients who underwent primary lip repair by one of two techniques: classical Millard with primary nasal correction (n = 30) or modified Millard without nasal correction (n = 45). Control group of ten-year-old school children (n = 45). METHODS Nasal asymmetry of participants was measured from facial photographs taken in two views: frontal and basal. The Symnose computer program was used to calculate asymmetry for three parameters: front perimeter (FP), base perimeter (BP) and nostrils (N). Total asymmetry was also calculated. Each image was traced on three separate occasions and a mean of the three measurements was calculated. RESULTS BP, N and total asymmetry were significantly greater in UCLP patients without nasal correction compared to both controls and patients with correction (BP = 12.73% v 4.90% v 6.75%, N = 47.73% v 15.83% v 30.75%, total = 81.87% v 46.43% v 54.68%, p ≤ 0.001). FP asymmetry was significantly greater in controls than all UCLP patients (22.87% v. 18.18% and 15.07%, p = 0.001 and p = 0.008). BP measurements have a higher degree of repeatability than FP and N (Coefficient of repeatability = 5.99, 17.02 and 16.47, respectively). CONCLUSIONS Primary nasal correction produces greater nasal symmetry during childhood from the basal view. Symnose is a simple method of objectively measuring asymmetry in UCLP, however improvements are required before it can be considered a useful research tool.
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Affiliation(s)
- A K Freeman
- South West Cleft Unit, Frenchay Hospital, Frenchay, Bristol BS16 1LE, United Kingdom
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Lip Height Improvement during the First Year of Unilateral Complete Cleft Lip Repair Using Cutting Extended Mohler Technique. PLASTIC SURGERY INTERNATIONAL 2012; 2012:206481. [PMID: 23316354 PMCID: PMC3539341 DOI: 10.1155/2012/206481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Accepted: 12/01/2012] [Indexed: 02/05/2023]
Abstract
Objective. To compare the cutaneous lip height at early and late postoperative periods and to objectively determine the average amount of lip height improvement during the first year of unilateral complete cleft lip repair using Cutting extended Mohler technique. Methods. In this prospective cohort study, 26 unilateral complete cleft patients and 50 noncleft subjects were included. Photographs were taken between 12 and 16 weeks (T1) and also taken between 12 and 13 months after surgery (T2). The cutaneous lip height distance (photogrammetric lip analysis) obtained in these two periods of time were measured and statistically analyzed. Results. The average lip heights were 24% ± 9% in T1 and 8% ± 6% in T2 (P < 0.01). The average lip height asymmetry in the noncleft individuals was 4.52% ± 1.89%. Conclusion. Since all principles to obtain a symmetrical Cupid's bow were performed, the postoperative pull-up of Cupid's bow is probably owed to the scar contracture, which improves by 2 times during the first year after surgery.
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Paiva TS, Andre M. Evaluating aesthetics of the nasolabial region in children with cleft lip and palate: professional analysis and patient satisfaction. Patient Prefer Adherence 2012; 6:781-7. [PMID: 23152672 PMCID: PMC3496535 DOI: 10.2147/ppa.s36656] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Cleft lip and palate is one of the most common deformities of the craniofacial region, and treatment of this deformity is essential for social reintegration. One of the major goals of surgery and treatment of craniofacial deformities is to improve the aesthetic appearance of the face, and thereby improve the patient's social acceptability. Here, we present a critical review of the criteria for aesthetic evaluation of the nasolabial region in cleft patients by assessing publications with the highest level of evidence, including professional evaluation, and patient satisfaction. The findings indicate treatment of this condition represents a major challenge for multidisciplinary team care.
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Affiliation(s)
- Tatiana Saito Paiva
- Correspondence: Tatiana Saito Paiva, Alves Guimaraes # 470, Apt 93, Sao Paulo, Brazil, 05410000, Tel +55 112 548 6900, Fax +55 112 548 6906, Email
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