Soft-tissue profile growth in patients with repaired complete unilateral cleft lip and palate: A cephalometric comparison with normal controls at ages 7, 11, and 18 years

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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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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A Retrospective Comparison of Craniofacial Form in Northern Irish Children with Unilateral Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_1998_035_0402_arcocf_2.3.co_2 ◽

1998 ◽

Vol 35 (5) ◽

pp. 402-407 ◽

Cited By ~ 4

Author(s):

Alan G. Leonard ◽

Brian Kneafsey ◽

Stephen Mckenna ◽

Chris D. Johnston ◽

Donald J. Burden ◽

...

Keyword(s):

Soft Tissue ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Dental Arch ◽

Cephalometric Analysis ◽

Northern Irish ◽

Ranking System ◽

Facial Contour ◽

Soft Tissue Profile

Objective This study evaluated the craniofacial form of a sample of Northern Irish children with unilateral cleft lip and palate (UCLP). The quality of the outcomes achieved was compared with the outcomes reported for the six centers involved in the European multicenter study (Mars et al., 1992; Mølsted et al, 1992). Design Retrospective analysis. Patients All children born with complete skeletal UCLP in Northern Ireland during the years 1983 to 1987. Main outcome Measures Cephalometric analysis was used to determine the craniofacial form and soft tissue profile. The quality of the dental arch relationships was independently assessed using the Goslon ranking system. Results The sample comprised 25 children with complete skeletal UCLP who had cephalometric radiographs and study casts recorded at a mean age of 9.4 years (range, 8 to 11 years). Cephalometric analysis revealed no important skeletal differences between the Northern Irish UCLP children and the published results from the six Eurocleft centers. The soft tissue profile of the Northern Irish UCLP children was significantly more convex than the soft tissue profile recorded for center D in the Eurocleft study. The Goslon ranking system revealed that 18 (72%) of the Northern Irish UCLP children had good or satisfactory dental arch relationships. Conclusions No clinically important differences were detected between the mean cephalometric skeletal parameters of the Northern Irish UCLP children and those published for the six cleft centers involved in the Eurocleft study. On average, the Northern Irish UCLP children were found to differ significantly from Eurocleft's center D in their soft tissue facial contour and sagittal lip profile. The quality of the dental arch relationships of the Northern Irish sample was between the best and the less good Eurocleft centers.

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A Six-Center International Study of Treatment Outcome in Patients with Clefts of the Lip and Palate: Part 2. Craniofacial Form and Soft Tissue Profile

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_1992_029_0398_asciso_2.3.co_2 ◽

1992 ◽

Vol 29 (5) ◽

pp. 398-404 ◽

Cited By ~ 54

Author(s):

Kirsten Mølsted ◽

Catherine Asher-Mcdade ◽

Viveca Brattström ◽

Erik Dahl ◽

Michael Mars ◽

...

Keyword(s):

Treatment Outcome ◽

Soft Tissue ◽

Cleft Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Craniofacial Morphology ◽

Facial Morphology ◽

X Rays ◽

Full Cohort ◽

Soft Tissue Profile

The craniofacial morphology and the soft tissue profile were evaluated in this part of the intercenter study of the European Cleft Lip and Palate Research Group. The sample was comprised of cephalometric x-rays of the full cohort of 151 cases from the six European cleft palate centers. The facial morphology in complete unilateral cleft lip and patate patients was evaluated by means of roentgen cephalometry. Approximately 25 consecutive cases from each of six European cleft palate centers were compared. Only one center showed notable and consistent differences from the others. A contributing factor for these differences may be an inconsistent treatment regimen with many surgeons involved. Analysis of the soft tissue profile between the centers showed more pronounced differences than analysis of the skeletal profile. The treatment outcome in centers with more complex or expensive programs was no better than those centers using simpler management approaches.

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