A longitudinal study of postoperative changes in the soft-tissue profile in bilateral cleft lip and palate from birth to 6 years

Objective: To evaluate the soft tissue profile and frontal photographs of 8- to 12-year-old patients with repaired complete bilateral cleft lip and palate (BCLP). Methods: The profile and frontal photographs obtained from 31 nonsyndromic BCLP children (aged 8-12 years: 14 boys and 17 girls) were analyzed and compared with an age- and sex-matched normal population (18 boys and 32 girls). In each patient, 12 soft tissue angular and proportional parameters on the frontal photograph and 12 angular parameters for the profile photographs were developed and measured. Student t test was used to compare the mean value of the parameters between both sexes. Results: In the frontal view, there was a significant difference between the 2 study groups in the facial symmetry angle ( P < .001), lower facial height proportion ( P < .001), upper lip proportion ( P < .001), and interalar width/distance between the inner canthus of the eyes ( P < .001). In the profile view, there was a significant difference between the control group and the patients with cleft lip and palate in terms of nasofrontal angle ( P < .001), nasal angle ( P < .001), angle of the inferior facial third ( P = .032), head position angle ( P < .001), facial convexity angle ( P < .001), total facial convexity angle ( P < .001), and vertical nasal angle ( P < .001). Conclusion: In comparison with the normal population, the face of patients with repaired BCLP showed several soft tissue deformities, especially in the nasofrontal region, even after a surgical repair.

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A Quantitative Three-Dimensional Assessment of Abnormal Variations in Facial Soft Tissues of Adult Patients with Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_2003_040_0544_aqtaoa_2.0.co_2 ◽

2003 ◽

Vol 40 (5) ◽

pp. 544-549 ◽

Cited By ~ 6

Author(s):

Virgilio F. Ferrario ◽

Chiarella Sforza ◽

Claudia Dellavia ◽

Gianluca M. Tartaglia ◽

Davide Sozzi ◽

...

Keyword(s):

Soft Tissue ◽

Cleft Lip ◽

Soft Tissues ◽

Cleft Lip And Palate ◽

Three Dimensional ◽

Z Score ◽

Soft Tissue Profile ◽

Variability Index ◽

The Mean ◽

Facial Soft Tissues

Objective To supply quantitative information about the facial soft tissues of adult operated patients with cleft lip and palate (CLP). Design, Setting, and Patients The three-dimensional coordinates of soft tissue facial landmarks were obtained using an electromagnetic digitizer in 18 Caucasian patients with CLP (11 males and 7 females aged 19 to 27 years) and 162 healthy controls (73 females and 89 males aged 18 to 30 years). From the landmarks, 15 facial dimensions and two angles were calculated. Data were compared with those collected in healthy individuals by computing z-scores. Two summary anthropometric measurements for quantifying craniofacial variations were assessed in both the patients and reference subjects: the mean z-score (an index of overall facial size), and its SD, called the craniofacial variability index (an index of facial harmony). Results In treated patients with CLP, facial size was somewhat smaller than in normal individuals, but in all occasions the mean z-score fell inside the normal interval (mean ± 2 SD). Almost all patients had a craniofacial variability index larger than the normal interval, indicating a global disharmonious appearance. Overall, in patients pronasale, subnasale, and pogonion were more posterior, the nose was shorter and larger, the face was narrower, and the soft tissue profile and upper lip were flatter than in the reference population. Conclusions The facial soft tissue structures of adult operated patients with CLP differed from those of normal controls of the same age, sex, and ethnic group. In this patient group, surgical corrections of CLP failed to provide a completely harmonious appearance, even if the deviations from the reference were limited. Further analyses of larger groups of patients are needed.

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Soft-Tissue Profile Changes during Widening and Protraction of the Maxilla in Patients with Cleft Lip and Palate Compared with Normal Growth and Development

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_1993_030_0454_stpcdw_2.3.co_2 ◽

1993 ◽

Vol 30 (5) ◽

pp. 454-468 ◽

Cited By ~ 6

Author(s):

Rolf S. Tindlund ◽

Per Rygh

Keyword(s):

Soft Tissue ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Lower Lip ◽

Maxillary Protraction ◽

Transverse Expansion ◽

Short Period ◽

Soft Tissue Profile ◽

Lateral Cephalograms ◽

Maxillary Deficiency

During the last 15 years, cleft lip and palate (CLP) patients with maxillary deficiency in the care of the Bergen CLP team have undergone an interceptive orthopedic treatment phase during the deciduous and mixed dentition period. The present study includes 68 patients who received maxillary transverse expansion by use of a modified quad-helix appliance and 98 cases given maxillary protraction by a facial mask. All cases were treated until an acceptable normal occlusion was attained. Lateral cephalograms were taken immediately before and after the active treatment periods. Sagittal changes of the soft-tissue profile during transverse expansion and protraction were analyzed separately for unilateral complete cleft lip and palate (UCLP) patients and bilateral complete cleft lip and palate (BCLP) patients. The soft-tissue profiles of the groups were compared to growth changes of noncleft age-matched children (NORM group). During the short period of maxillary transverse expansion (mean period, 3.5 months) no significant change of the soft-tissue profile was found, except in the protrusion of the lower lip in the BCLP group. During the period of maxillary protraction (mean periods, 12 months in the UCLP group and 15 months in the BCLP group) the soft-tissue profile improved significantly by reducing the characteristic tendency towards a concave profile in CLP patients with maxillary deficiency. Significant Increases of the sagittal maxillomandlbular lip relation (angle SS-N-SM: mean Increase, 2.5 degrees) and the Holdaway-angle (H-angle: mean increase, 3.0 degrees) were found to be similar in the UCLP and BCLP groups. However, the use of different reference lines for evaluation of treatment effects upon the soft-tissue profile resulted in conflicting findings suggesting that anteriorly situated reference lines are more suitable for the evaluation of CLP patients. Thus, the esthetic line (E.line) indicated a favorable position of the lips after treatment; the subspinale-pogonlon line (ss.pg) revealed an Improved soft-tissue profile; the soft-tissue-facial line (N.PG) showed a retruded nose and upper lip; whereas basal references such as the nasion-sella line (NSL) and the occlusal-line perpendicular (OLP) mainly showed major differences between the CLP groups and the NORM groups.

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Facial Growth in Patients with Bilateral Cleft Lip and Palate: A Cephalometric Study

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_1994_031_0210_fgipwb_2.3.co_2 ◽

1994 ◽

Vol 31 (3) ◽

pp. 210-216 ◽

Cited By ~ 13

Author(s):

Kiki L.W.M. Heidbüchel ◽

Anne Marie Kuijpers-Jagtman ◽

Hans Peter M. Freihofer

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

University Hospital ◽

Long Term Results ◽

Facial Growth ◽

Nasolabial Angle ◽

Comparison Results ◽

Soft Tissue Profile ◽

Lateral Cephalograms ◽

Bilateral Cleft Lip

In this study, sagittal facial growth of bilateral cleft lip and palate (BCLP) patients between 6 and 20 years of age is analyzed. The data of Nljmegen were derived from 131 lateral cephalograms taken in 21 BCLP patients who were treated In the Cleft Lip and Palate Center of the University Hospital of Nljmegen. Reported data of 90 BCLP patients treated at the Center of Oslo were used as a reference for comparison. Results of this Investigation showed mandibular growth to be similar in both centers. In the premaxillary region some differences were found: The Nljmegen patients presented a more protrusive premaxilla than those at Oslo. The upper front teeth and hence, the premaxilla, were more retroclined In the Nljmegen sample. There were also statistically significant differences in the soft tissue profile. The mean z-score was positive for the nasolabial angle and negative for the angle N'-Sn-Pg'. At 18 years of age, these differences are still apparent. In comparison with Broadbent's values of normal individuals, the SNPg-angle was smaller and the mandibular angle greater in Nljmegen and Oslo. The profiles of the BCLP patients are more convex in Nljmegen and more concave in Oslo than In the noncleft group. Finally, the different treatment strategies of the Cleft Lip and Palate Centers of Nljmegen and Oslo are compared and discussed In terms of their long-term results.

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Longitudinal Study of Effect of Hotz's Plate and Lip Adhesion on Maxillary Growth in Bilateral Cleft Lip and Palate Patients

The Cleft Palate-Craniofacial Journal ◽

10.1597/10-042 ◽

2012 ◽

Vol 49 (2) ◽

pp. 230-236 ◽

Cited By ~ 5

Author(s):

Muhammad Syafrudin Hak ◽

Masaaki Sasaguri ◽

Farida Kamil Sulaiman ◽

Enny Tyasandarwati Hardono ◽

Akira Suzuki ◽

...

Keyword(s):

Longitudinal Study ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Maxillofacial Surgery ◽

University Hospital ◽

Dental Arch ◽

Prospective Longitudinal Study ◽

Bilateral Cleft Lip ◽

Maxillary Growth ◽

Prospective Longitudinal

Objective To investigate the effects of infant orthopedic treatment and lip adhesion on maxillary growth of patients with bilateral cleft lip and palate (BCLP). Design Prospective longitudinal study. Setting The present study was conducted at the Cleft Lip and Palate Center, Harapan Kita Children and Maternity Hospital, Indonesia, and the Department of Oral and Maxillofacial Surgery, Kyushu University Hospital, Japan. Subjects The study sample consisted of 53 patients with complete BCLP and 10 noncleft patients with other diseases. Patients with BCLP were divided into three groups: H (-), 11 patients treated without Hotz's plate; H (+), 24 treated with Hotz's plate; and LA-H, 18 treated with lip adhesion and Hotz's plate. Methods Serial dental casts were obtained from each BCLP child at the following four time points: first visit, labioplasty, palatoplasty, and 5 years of age. Each maxillary dental cast was scanned, and the linear and angular dimensions were measured. Results and Conclusion Lip adhesion showed a temporary negative effect. In all patients with BCLP, the surgeries affected the growth of the anterior arch width until the age of 5 years. Collapse of the premaxilla following labioplasty in the H (-) group affected the growth of dental arch length until the age of 5 years. Treatment using Hotz's plate prevented collapse of the premaxilla, and the growth of the arch length was comparable to that observed in the noncleft group.

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A Cephalometric Appraisal of a Group of Children with Surgically Repaired Unilateral Cleft Lip and Palate

British Journal of Orthodontics ◽

10.1179/bjo.4.1.33 ◽

1977 ◽

Vol 4 (1) ◽

pp. 33-37 ◽

Cited By ~ 1

Author(s):

John B. Mowbray

Keyword(s):

Soft Tissue ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Normal Children ◽

Facial Height ◽

Soft Tissue Profile ◽

Base Reference ◽

Mandibular Retrusion ◽

Method Of Assessment ◽

Experimental Group

This study investigated the effect of a standard surgical technique for the repair of unilateral cleft lip and palate by one surgeon. Limitations were set by the numbers available for investigation, however comparison was made between a small group of such treated cases and a group of normal children. The method of assessment was based on a cephalometric analysis with extrapolation to the integumental profile. A number of different points were proposed for attributes of the soft tissue profile. The base reference line used was Sella-Nasion, points A and B and the extrapolations to the overlying soft tissue. Facial convexity was proposed as an angle subtended at the tip of the nose by the chin point and soft tissue nasion. Facial height was measured as a ratio between upper and lower facial dimensions. Lip tissue thickness was a direct measurement. The result of this study supported some findings in other studies. The point of most interest was the small amount of difference between the experimental group and the group used for comparison. Both maxillary and mandibular retrusion was noted and there appeared slight flattening of the soft tissue profile. However, no differences were noted in lip thickness and facial height.

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