110 infants with unrepaired unilateral cleft lip: An anthropometric analysis of the lip and nasal deformities

doi:10.1016/j.ijom.2010.04.007

International Journal of Oral and Maxillofacial Surgery

Volume 39, Issue 9, September 2010, Pages 847-852

https://doi.org/10.1016/j.ijom.2010.04.007 Get rights and content

Abstract

The aim of this retrospective study was to correlate the width of the cleft lip with the severity of the nasal deformity in unilateral cleft lip and palate (UCLP) patients before primary lip repair. Preoperative impression casts were made. Measurements were taken of the width of the cleft lip (CW), nose (NW), and nasal floor (NFW), alar base height (ABH), columella length (CL), nasal length (NL) and nasal tip protrusion (NTP). The ratio of the non-cleft side (NFW) to the cleft side (NFWR), the ratio of the non-cleft side (ABH) to the cleft side (ABHR), and the ratio of the cleft side (CL) to the non-cleft side (CLR) were calculated. The average NW, NL and CW were higher in the group with complete clefts. There was a negative linear relationship between CW and NFWR, and a positive linear relationship between CW and ABHR in the complete group. In the incomplete group, negative correlations were obtained between CW and NFWR and between CW and ABHR. These findings show that there are correlations between CW and the transverse and vertical imbalance of nose in both groups but not between CW and anteroposterior imbalance of nose.

Section snippets

Patients and method

Infants with unilateral cleft lip, with and without involving the palate (UCL ± P) were retrospectively enrolled in this study. Plaster casts of the faces in 110 UCL ± P patients, taken preoperatively, were selected in date order of presentation for surgery in the authors’ department. The 110 UCL ± P patients underwent primary lip repair at ages from 6 months to 8 months between 2004 and 2006. Among the 110 cleft children, 69 were complete UCLP patients, and 41 were incomplete UCL ± P patients. The

Mean values and range of values

The mean values for NFWR, ABHR, CLR and NTP were smaller in the complete cleft group. The mean values of NW, NL and CW were greater in this group. These differences were statistically significant (NFWR: P = 0.000; ABHR = 0.001; CLR = 0.000; NTP = 0.004; NW = 0.000; NL = 0.004; CW = 0.000). Means and ranges of values for all parameters in complete and incomplete clefts are shown in Table 1.

In the incomplete group, three ABHRs exceed 100% and five CLRs exceed 100%. No ABHR or CLR in the complete group exceeds

Discussion

Using the measurements of nasal deformity to evaluate the unilateral cleft was clinically useful, as surgical correction of the cleft nose can be one of the most challenging and frustrating aspects of the cleft lip surgery. At the time of primary correction, the difficulty of the correction is partly determined by the degree to which the edges of the cleft lip can be approximated under minimal tension. The width of the cleft lip was thought to be important in determining the degree of severity.

Competing interests

None declared.

Funding

None.

Ethical approval

Not required.

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Cited by (11)

Three-dimensional analyses of nasolabial forms and upper lip surface symmetry after primary lip repair in patients with complete unilateral cleft lip and palate
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To analyze three-dimensional (3D) nasolabial forms and upper lip surface symmetry after primary lip repair in children with unilateral cleft lip and palate (UCLP).
Subjects were 22 Japanese children with complete UCLP who underwent primary lip repair and were followed-up for 4–6 years. The 3D coordinates of facial landmarks and the angle and radius of the approximate nasal alar circle were calculated. Upper lip surface symmetry was analyzed using histogram intersection.
The nasal tip and columella base were slightly dislocated to the cleft side, and the midpoint of Cupid's bow shifted to the non-cleft side. The nasal alar and the top of Cupid's bow were reconstructed at the same height, while the approximate nasal alar circle was smaller on the cleft side. The mean value of similarity for upper lip surface symmetry was 0.82; a subject with a higher value had more symmetrical contour lines in the visualized surface image.
Postoperative nasolabial forms were almost restored to symmetrical levels, while retaining a small nasal alar. Histogram intersection is applicable as a method for the quantitative evaluation of upper lip surface symmetry in UCLP.
Three-dimensional facial anthropometry of unilateral cleft lip infants with a structured light scanning system
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MRI often requires a long examination time and general anaesthesia. The fabrication of plaster cast models22,23 has been used for many years, but its production is always associated with the disadvantage of soft-tissue deformation caused by the impression materials24 and the risk of anaesthesia. Recently, 3D imaging systems have played an increasingly important role in the field of craniofacial anthropometry.
Cleft lip in the presence or absence of a cleft palate is a major public health problem. However, few studies have been published concerning the soft-tissue morphology of cleft lip infants. Currently, obtaining reliable three-dimensional (3D) surface models of infants remains a challenge. The aim of this study was to investigate a new way of capturing 3D images of cleft lip infants using a structured light scanning system. In addition, the accuracy and precision of the acquired facial 3D data were validated and compared with direct measurements.
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The anthropometric data obtained using the 3D method were in agreement with the direct anthropometry measurements. All data calculated by the software were ‘highly reliable’ or ‘reliable’, as defined in the literature. The localisation of four landmarks was not consistent in repeated experiments of inter-observer reliability in preoperative images (P < 0.05), while the intra-observer reliability in both pre- and postoperative images was good (P > 0.05).
The structured light scanning system is proven to be a non-invasive, accurate and precise method in cleft lip anthropometry.
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Leading Clinical PaperCleft Lip and Palate110 infants with unrepaired unilateral cleft lip: An anthropometric analysis of the lip and nasal deformities

Abstract

Section snippets

Patients and method

Mean values and range of values

Discussion

Competing interests

Funding

Ethical approval

Br J Plastic Surg

Int J Surg

A comparative study of the skin envelope of the unilateral cleft lip nose subsequent to rotation-advancement and triangular flap lip repair

Plast Reconstr Surg

The anthropometric verification of corrective surgery outcome in cleft secondary deformities

J Craniofac Surg

Lip and nose morphology in patients with unilateral cleft lip and palate from four Scandinavia centers

Scand J Plast Reconstr Hand Surg

Anthropometry of the head and face in medicine

Morphology of adult face after repair of isolated cleft palate in childhood

Cleft Palate J

Nostril asymmetry: microform of cleft lip palate? An anthropometrical study of healthy North American Caucasians

Cleft Palate J

Anthropometric and anthroposcopic findings of the nasal and facial region in cleft patients before and after primary lip and palate repair

Cleft palate Craniofac J

Comparison of the morphology of the cleft face and the normal face-defining the anthropometric difference

J Craniofac Surg

Leading Clinical Paper
Cleft Lip and Palate
110 infants with unrepaired unilateral cleft lip: An anthropometric analysis of the lip and nasal deformities