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Chen Z, Yang J, Mao Q, Shi B, Li J, Yin X. Correlating Jaw Bone Growth and Nasal Morphology Among Adult Patients With Cleft Lip and Palate: A Retrospective Cephalometric Study. J Craniofac Surg 2024; 35:e405-e407. [PMID: 38666772 DOI: 10.1097/scs.0000000000010102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 01/22/2024] [Indexed: 06/04/2024] Open
Abstract
This retrospective cross-sectional study reviewed adult patients with operated cleft lip and/or palate (CL/P) and normal control, and performed comprehensive craniofacial and nasal morphological analyses based on lateral cephalometric radiographs. Pearson or Spearman correlation coefficient assessed intraclass correlation. Seven hundred fifty-seven operated patients with CL/P, and 165 noncleft normal controls were enrolled. Among the normal and CL/P groups, S-N-A angle registered positive correlations with nasal base prominence (S-N'-Sn, degrees). Upper facial height (N-ANS, mm) had positive correlations with nasal dorsum length (N'-Prn, mm) and nasal bone length (N-Na, mm). Although in patients with bilateral cleft lip and palate, there were moderate negative correlations ( r =-0.541, P <0.05) with soft tissue facial profile angle (FH-N'Pog', degree) and nasolabial angle (Cm-Sn-ULA, degree). Correlation exists between the morphology of jaw bones and external nose among patients with CL/P. Maxillary sagittal insufficiency is associated with concave nasal profile, and maxilla height is associated with nasal length.
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Affiliation(s)
- Zhuo Chen
- State Key Laboratory of Oral Diseases and National Center for Stomatology and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
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Chen Z, Cao C, Yang J, Mao Q, Shi B, Li J. A retrospective cephalometric study on the craniofacial morphology of adult patients with unoperated submucous cleft palate. J Craniomaxillofac Surg 2023; 51:702-707. [PMID: 37741800 DOI: 10.1016/j.jcms.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/10/2023] [Accepted: 08/10/2023] [Indexed: 09/25/2023] Open
Abstract
This retrospective cross-sectional study reviewed adult patients with unrepaired SMCP, OCP and normal control and performed comprehensive skeletal and soft tissue morphological analyses basing on lateral cephalometric radiographs. One way-ANOVA and rank-sum tests detected potential intergroup differences. 32 subjects with unrepaired SMCP, 42 with unrepaired OCP and 28 noncleft normal controls were enrolled. Both the SMCP and OCP groups were significantly different from the normal controls in sagittal maxillary length, jaw relationship, facial profile angle, nasal base and nasal tip prominence, upper lip position, and lower lip protrusion. S-N-A angle in the control group (82.25 ± 2.74°) was significantly greater than in the SMCP (77.96 ± 4.05°, p<0.001) and OCP (78.55 ± 2.93°, p<0.001) groups. Nasolabial angle in the control group (99.18 ± 8.76°) was significantly greater than in the SMCP (91.75 ± 8.93°, p = 0.002) and OCP (93.69 ± 7.24°, p = 0.020) groups. No significant difference was detected between the SMCP and the OCP group in other measurements except upper facial height. Within the limitations of the study it seems that craniofacial growth is impaired in patients with submucous clefts to the same extent as in patients with a conventional cleft palate.
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Affiliation(s)
- Zhuo Chen
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Congcong Cao
- Department of Oral & Maxillofacial Surgery, Weifang Traditional Chinese Hospital, Weifang, 261000, China
| | - Jun Yang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Qirong Mao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Bing Shi
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Jingtao Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.
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Zawiślak A, Wędrychowska-Szulc B, Grocholewicz K, Janiszewska-Olszowska J. Craniofacial Cephalometric Morphology in Caucasian Adult Patients with Cleft Palate Only (CPO). Diagnostics (Basel) 2023; 13:2058. [PMID: 37370953 DOI: 10.3390/diagnostics13122058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Orofacial clefts are common birth defects that affect the morphology of the skull. Cleft palate only (CPO) has a different etiology than other types of clefts, and craniofacial morphology in CPO differs from that of UCLP and BCLP. The long-term effect of the cleft and its surgery is visible after growth cessation. However, few studies exist describing cephalometric craniofacial morphology in adults with CPO. The aim of the present study was to describe the cephalometric craniofacial morphology of adult patients with CPO compared to healthy patients. The study included analysis of cephalometric lateral headfilms of 28 adults with CPO and 28 healthy subjects. It was found that the angles of SNA, ANB, 1-:NB angle (°) and Wits appraisal were significantly smaller in CPO, whereas NL-NSL (°), 1+:NA angle (°) and 1+:NA (mm) had significantly higher values in CPO compared to the control group. It has been concluded that CPO in adult patients is characterized by a sagittal jaw discrepancy due to maxillary deficiency, with a tendency for compensatory inclination of the upper and lower incisors.
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Affiliation(s)
- Alicja Zawiślak
- Department of Orthopaedics and Orthodontics, Institute of Mother and Child, ul. Kasprzaka 17a, 01-211 Warszawa, Poland
- Department of Interdisciplinary Dentistry, Pomeranian Medical University, al. Powstańców Wlkp 72, 70-111 Szczecin, Poland
| | | | - Katarzyna Grocholewicz
- Department of Interdisciplinary Dentistry, Pomeranian Medical University, al. Powstańców Wlkp 72, 70-111 Szczecin, Poland
| | - Joanna Janiszewska-Olszowska
- Department of Interdisciplinary Dentistry, Pomeranian Medical University, al. Powstańców Wlkp 72, 70-111 Szczecin, Poland
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Janiszewska-Olszowska J, Grocholewicz K, Mazur M, Jedliński M. Influence of Primary Palatal Surgery on Craniofacial Morphology in Patients with Cleft Palate Only (CPO)-Systematic Review with Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14006. [PMID: 36360890 PMCID: PMC9657752 DOI: 10.3390/ijerph192114006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 10/09/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Cleft palate only (CPO) is the second most prevalent cleft type. Both the cleft and palatal scarring may affect craniofacial growth. The aim of this systematic review was to summarize scientific evidence on effect of palatal surgery on craniofacial morphology in CPO. METHODS A search was conducted in PubMed, PMC, WoS, Scopus, Embase, using the keywords: "cleft palate" AND ("craniofacial morphology" OR "cephalometric analysis") NOT "lip" with inclusion and exclusion criteria ensuring confident, direct comparison between study groups. The quality assessment was performed with Arrive's scale for radiologic examinations. RESULTS Of 713 potential articles, 19 were subjected to qualitative analysis and 17 to meta-analysis, which confirmed reduced SNA in unoperated CPO versus non-cleft individuals. No scientific evidence was found directly assessing the effect of surgery on craniofacial morphology. The negative effect of palatal surgery was seen indirectly: in treated CPO versus non-cleft, the size effect of SNA is bigger than in untreated CPO versus non-cleft. A high heterogeneity came from a few non-European publications. CONCLUSIONS CPO is associated with sagittal maxillary deficiency resulting both from the cleft and from primary surgery, disregarding cleft severity in operated CPO patients. Ethnic differences influence craniofacial morphology in CPO. This research received no external funding. Study protocol number in PROSPERO database: CRD42021268957.
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Affiliation(s)
| | - Katarzyna Grocholewicz
- Department of Interdisciplinary Dentistry, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland
| | - Marta Mazur
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Maciej Jedliński
- Department of Interdisciplinary Dentistry, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland
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Lin X, Li HY, Xie QT, Zhang T, Huang XP, Zhou N. The Soft Tissue Angular Analysis of Facial Profile in Unoperated Adult Patients with Unilateral Cleft Palate. Aesthetic Plast Surg 2019; 43:982-992. [PMID: 30963186 DOI: 10.1007/s00266-019-01371-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/24/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the differences in facial profile development between unoperated adult cleft palate (UACP) patients and normal controls and to analyse the reasons for the differences. MATERIALS AND METHODS A total of 50 individuals with a unilateral cleft palate and 20 normal controls were selected to undergo angular measurement of their facial profiles. Data with significant differences between the two groups were analysed. RESULTS Seven angle measurements of the facial profile showed that the mid-facial protrusion of the UACP patients had no significant differences from the control group (p > 0.05). But their angle of the medium face (N'-Trg-Sn) was significantly lower than the non-cleft controls (p < 0.05), suggesting a worse vertical development of the middle face. A significantly larger nasal tip angle (Cm-Sn/N'-Prn) for UACP patients suggested they had a rounder and blunter nasal tip (p < 0.05). The soft tissue facial angle and chin-lip angle of UACP patients had significant differences from non-cleft controls (p < 0.05), but the head position angle (Sn-Sm-THP) had no significant difference between two groups (p > 0.05), which suggested a steep mandibular plane for UACP patients but without severe retraction of the chin. CONCLUSION The development of facial protrusions in UACP patients is similar to that in normal adults, but the vertical development in the middle face is insufficient. Such hypoplasia may be related to the intrinsic deficiency of the maxilla. There is a tendency for flat nasal growth and insufficient development of the chin in UACP patients. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Cao C, Xu X, Zheng Q, Shi B, Li J, Wang Y. Growth and Development of Craniofacial Structures in Patients at Different Ages With Unrepaired Submucous Cleft Palate. J Oral Maxillofac Surg 2018; 76:2388-2397. [PMID: 29679588 DOI: 10.1016/j.joms.2018.03.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 03/18/2018] [Accepted: 03/21/2018] [Indexed: 02/05/2023]
Abstract
PURPOSE Submucous cleft palate (SMCP) is a particular subtype of cleft palate deformity; research related to the craniofacial features of patients with SMCP is comparatively rare. The study objective was to perform a cephalometric comparison of the craniofacial features of patients with SMCP and non-cleft controls at different ages. MATERIALS AND METHODS The sample in this cross-sectional study was composed of 2 groups: SMCP patients and non-cleft controls. The primary predictor variables were study group (cleft and non-cleft) and age. Age was divided into 3 groups. The outcome variables of interest were craniofacial measurements. The measurements used reflect cranial length, cranial angle, maxillary sagittal length and protrusion, maxillary vertical height, pharyngeal depth, facial height, mandibular length and protrusion, mandibular plane angle, and intermaxillary relation. Adjusted cephalometric craniofacial measurements between the groups were compared in 3 age groups using generalized linear models after being adjusted for age and gender. RESULTS The study included 60 SMCP patients and 60 non-cleft controls. SMCP patients and non-cleft controls were divided into 3 subgroups: those aged 5 to 7 years, those aged 9 to 11 years, and those aged 18 to 30 years. Patients with SMCP at age 5 to 7 years showed a shortened cranial base length, maxillary sagittal length and height, and bony pharynx depth. Patients with SMCP at age 9 to 11 years showed a smaller maxillary sagittal length and bony pharynx depth and an inharmonious jaw relationship. Patients with SMCP at age 18 to 30 years showed a smaller maxillary sagittal length and height and an inharmonious jaw relationship. CONCLUSIONS SMCP is associated with progressive maxillary retrognathism and reduced profile convexity from childhood to adulthood.
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Affiliation(s)
- Congcong Cao
- Resident, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xue Xu
- Attending Physician, Department of Plastic and Traumatic Surgery, Beijing Stomatology Hospital, Capital Medical University, Beijing, China
| | - Qian Zheng
- Attending Physician, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Bing Shi
- Professor, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jingtao Li
- Professor, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yan Wang
- Associate Professor, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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