Analysis of Dental Arch Symmetry of Children With Unilateral Cleft Lip and Palate: Seven-Year Follow-Up

BACKGROUND

Orofacial cleft is the most common craniofacial deformity, resulting in facial anatomical disorders.

AIM

To evaluate maxillary dental arch symmetry of children with unilateral complete cleft lip, alveolus, and palate before and after primary surgeries.

DESIGN

A total of 27 dental casts were analyzed: (T1) Presurgical; (T2) Postsurgical 1; and (T3) Postsurgical 2. Six linear measurements were analyzed (I-C', I-C, I-T', I-T, C'-T', and C-T). Paired t test, Pearson correlation, and ANOVA, followed by the Tukey test, were conducted (α = 5%).

RESULTS

The asymmetry was confirmed by I-C versus I-C' across all periods and I-T versus I-T' (at T1). The Pearson correlation test showed significant values for Δ1×Δ2 and Δ1×Δ3, but not for Δ2×Δ3. The longitudinal analysis showed that the I-C' mean was greater at T1 than at T2/T3 (p < 0.001). The I-C mean was smaller at T1 than at T2/T3 (p < 0.001). I-T' was greater only at T3 (p < 0.001). I-T, C'-T', and C-T means were greater at all periods.

CONCLUSION

The maxillary asymmetry of children with unilateral cleft lip and palate is inherent to the cleft type, evidenced by the maxillary hypoplasia in the smaller segment, probably higher in the anterior region (I-C').

Three-Dimensional Quantification of Postoperative Facial Asymmetry in Patients With Unilateral Cleft lip and Palate Using Facial Symmetry Plane

OBJECTIVE

To quantitatively assess three-dimensional (3D) soft tissue facial asymmetry in patients with unilateral cleft lip and palate (UCLP) who have undergone primary lip repair.

DESIGN

Clinical, retrospective, comparative, methodological study.

PATIENTS/PARTICIPANTS

Twenty patients with UCLP were selected after a review of the records.

INCLUSION CRITERIA

Complete UCLP; surgically treated without secondary repair. An age-matched and sex-matched Control group was employed.

MAIN OUTCOME MEASURES

A 3D facial symmetry plane (FSP) was obtained by superimposing the point clouds of the original 3D facial image excluding the surgical site and including lip and nose areas and those of a mirrored facial image using the iterative closest point (ICP) adjustment method. The discrepancies in the depth and angle of the normal vector of the facial surface of each point cloud between right and left sides (cleft and non-cleft sides in the UCLP group, respectively) based on FSP were calculated.

RESULTS

Facial asymmetry in the UCLP group was significantly greater than in the Control group regarding both the discrepancies in the depth (1.34 ± 0.62, 0.73 ± 0.32 pixels, respectively) (P = .0004) and surface angle (18.0 ± 5.88, 12.8 ± 4.0°, respectively) (P = .0024). Biaxial assessment of the discrepancies in the depth and surface angle allowed us to visually extract UCLP patients with greater facial asymmetry.

CONCLUSIONS

Facial asymmetry analysis based on 3D FSP effectively facilitates the facial asymmetry quantification and soft tissue surgical outcome evaluation in patients with UCLP.

Utilization of images and three-dimensional custom-made nostril retainer fabricate for patients with cleft lip and cleft lip nose deformities at Siriraj Hospital: preliminary phase

A prospective study utilizing image analysis to assess nostril openings in post-operative patients with cleft lip and cleft lip nose deformities. This preliminary study seeks to employ two-dimensional (2D) images to fabricate a custom-made nostril retainer. This study was performed at Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand. This study included 30 healthy volunteers and 15 patients with cleft lip and cleft lip nose deformities. The nostril opening width and height for all participants were measured, and photographs were taken. An image analysis application was used to fabricate a three-dimensional (3D) custom-made nostril retainer. The mean differences between the direct measurements of the nostril aperture and the measurements obtained through the program did not exceed 2 mm in terms of nostril height, width, or columella. Two-dimensional photographs can be used to create a custom-made, three-dimensional nostril retainer. This retainer allows post-operative patients to maintain their nares without needing to visit the hospital, thereby reducing the cost of care.

Philtral Ridge Projection in Repaired Unilateral Cleft Lip: Three-Dimensional Anthropometry

BACKGROUND

Cleft surgeons try to construct a philtral ridge during primary repair of a cleft lip, but rarely document the results. The authors used three-dimensional photogrammetry to measure projection of philtral ridges after closure of the common forms of unilateral labial cleft.

METHODS

This is a retrospective study of patients with unilateral complete, incomplete (moderate and severe), and microform cleft lip repaired by one surgeon from 2000 to 2013. Cleft type determined the technique for building a philtral ridge. The relative elevation of the ridge on the cleft versus noncleft side was measured on three-dimensional childhood photographs at two locations along the philtrum: just above the Cupid's bow and at the midlabial level.

RESULTS

Thirty-four patients were evaluated at a mean age of 9.25 years. All cleft types exhibited greater projection at the philtral midlabial level compared with the Cupid's bow level. The authors found a trend toward a more prominent cleft side philtral ridge in microforms. In incomplete cleft lips, there was slightly greater philtral ridge projection in severe forms repaired after a preliminary nasolabial adhesion compared with those repaired in a single stage. There was similar projection of the cleft side ridge in two-stage complete and single-stage repaired incomplete lips.

CONCLUSIONS

It is possible to construct a philtral ridge that is as prominent as the noncleft side in all types of unilateral cleft lip. Increased muscle thickness may explain the slightly increased philtral ridge projection in patients with an incomplete cleft repaired in two stages compared to one-stage closure.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.