Visual and Statistical Modeling of Facial Movement in Patients with Cleft Lip and Palate

Objective To analyze and display facial movement data from noncleft subjects and from patients with cleft lip and palate by using a new dynamic approach. The hypothesis was that there are differences in facial movement between the patients with cleft lip and palate and the noncleft subjects. Setting Subjects were recruited from the University of North Carolina School of Dentistry Orthodontic and Craniofacial Clinics. Patients, Participants Sixteen patients with cleft lip and palate and eight noncleft “control” subjects. Interventions Video recordings and measurements in three dimensions of facial movement. Main Outcome Measures Principal component (PC) scores for each of six animations or movements and dynamic modeling of mean animations. Statistics Multivariate statistics were used to test for significant differences in the PC mean scores between the patient groups and the noncleft groups. Results No statistically significant differences were found in PC mean scores between the patient groups and the noncleft groups; however, the variability of the effect of clefting on the soft tissues during animation was noted when the noncleft data were used to establish a “normal” scale of movement. Compensatory movements were seen in some of the patients with cleft lip and palate, and the compensation was not unidirectional. Conclusion Measures of mean movement differences as summarized by PC scores between patients with cleft lip and palate and noncleft subjects may be misleading because of extreme variations about the mean in the patient group that may neutralize group differences. It may be more appropriate to compare patients to a noncleft normal scale of movement.

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Orthodontic Pre Grafting Closure of Large Alveolar Bony and Soft Tissue Gaps: A Novel Nonsurgical Protraction of the Lesser Segments in Growing Patients With Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211007697 ◽

2021 ◽

pp. 105566562110076

Author(s):

Maria Costanza Meazzini ◽

Noah Cohen ◽

Valeria Marinella Augusta Battista ◽

Cristina Incorvati ◽

Federico Biglioli ◽

...

Keyword(s):

Soft Tissue ◽

Surgical Procedures ◽

Efficient Method ◽

Bone Grafting ◽

Cleft Lip ◽

Soft Tissues ◽

Cleft Lip And Palate ◽

Face Mask ◽

Younger Patients ◽

Good Healing

Background: Closure of wide alveolar clefts with large soft tissue gaps and reconstruction of the dentoalveolar defect are challenging for the surgeon. Some authors successfully used interdental segmental distraction, which requires an additional surgical procedure. Objective: This study evaluates the effectiveness of tooth borne devices utilized to orthopedically advance the lesser segments, with a complete approximation of the soft tissue of the alveolar stumps, allowing traditional simultaneous soft tissue closure and bone grafting, and avoiding the need for supplementary surgery. Methods: Eight growing patients, 2 with unilateral complete cleft lip and palate (UCLP) and 6 with bilateral complete cleft lip and palate (BCLP), with large soft tissue and bony alveolar defects prior to bone grafting were prospectively selected. A banded rapid palatal expander (RPE) in BCLP and a modified RPE in UCLP combined with protraction face mask in younger patients or a modified Alt-Ramec in patients older than 12 years were applied. Radiographic and photographic records were available at T0, at the end of protraction (T1) and at least 1 year after bone grafting (T2). Results: Patients with large gaps showed a significant reduction in the bony cleft area and approximation of the soft tissues at T1. All patients received bone grafting with good healing and ossification at T2. Conclusion: In growing patients with UCLP and BCLP with large gaps, presurgical orthodontic protraction seems to be an efficient method to reduce the cleft defect, minimizing the risk of post grafting fistulas, reducing the need for supplementary surgical procedures.

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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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Bone-anchored maxillary protraction in patients with unilateral cleft lip and palate:

The Angle Orthodontist ◽

10.2319/091919-598.1 ◽

2020 ◽

Vol 90 (4) ◽

pp. 539-547 ◽

Cited By ~ 1

Author(s):

Eman H. Elabbassy ◽

Noha E. Sabet ◽

Islam T. Hassan ◽

Dina H. Elghoul ◽

Marwa A. Elkassaby

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Three Dimensions ◽

Class Iii ◽

Maxillary Expansion ◽

Forward Movement ◽

Maxillary Protraction ◽

Computed Tomography Images ◽

Group I ◽

Effective Treatment Modality

ABSTRACT Objectives To assess the effectiveness of bone-anchored maxillary protraction (BAMP) in patients with unilateral cleft lip and palate (UCLP) and whether it was enhanced when preceded by maxillary expansion. Materials and Methods The sample consisted of 28 growing children (9–13 years old) with UCLP and Class III malocclusion. They were divided into two equal groups. In group I, patients were treated with BAMP not preceded by maxillary expansion. In group II, patients were treated with BAMP preceded by maxillary expansion. To assess treatment changes in three dimensions, Cone-beam computed tomography images were taken 1 week after surgical placement of the miniplates (T1) and after 9 months of treatment (T2). Results BAMP produced forward movement of the maxilla in both groups (3.17 mm) and (3.37 mm) respectively, without significant differences between the two groups except for clockwise rotation of the palatal plane in group I (1.60). Conclusions BAMP is an effective treatment modality for correcting midface deficiency in patients with UCLP whether or not maxillary expansion was carried out.

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Validity of Subjective Evaluations for the Assessment of Lip Scarring and Impairment

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_2002_039_0587_voseft_2.0.co_2 ◽

2002 ◽

Vol 39 (6) ◽

pp. 587-596 ◽

Cited By ~ 11

Author(s):

Kelly Ritter ◽

Carroll-Ann Trotman ◽

Ceib Phillips

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Subjective Assessment ◽

Future Research ◽

Subjective Evaluations ◽

Subjective Assessments ◽

Interexaminer Reliability ◽

School Of Dentistry ◽

The University ◽

The Impact

Objective In patients with cleft lip and palate, the aim of the study was (1) to determine and compare the level of agreement among examiners’ subjective evaluations of static and dynamic lip form; (2) assess possible bias of examiners’ subjective evaluations; and (3) determine the impact of lip scarring on an examiner's subjective assessment of dynamic lip form. Setting Patients and subjects were recruited from the University of North Carolina Cleft Lip and Palate Center and School of Dentistry. Patients, Participants Thirteen patients with unilateral cleft lip and palate and varying degrees of cleft scar severity were selected and one subject without cleft who wore artificial scars of varying severity. Interventions For the patients with cleft, a previously repaired complete cleft lip and palate. Photographs and videotape recordings were made of the patients with cleft and the subject without cleft, with and without the artifical scars, at rest and smiling. Main Outcome Measure(s) Rankings of cleft scar severity and impairment on a 6-point Likert scale by a lay and professional panel. Results Intra- and interexaminer reliability was good for the lower facial regions at rest but not during movement. Professionals gave ratings of greater severity and impairment than laypersons, and professionals agreed when rating the lower faces at rest more so than during movement. Lip scarring affected perceptions of impairment during movement by viewers in both panels. Conclusions Subjective assessments can be affected by methodological approaches, professional experience, and stimulus type. Future research should focus on establishing objective methods to evaluate patients with cleft lip and palate at rest and during function.

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Pattern of Morphological Variability in Unrepaired Unilateral Clefts With and Without Cleft Palate May Suggest Intrinsic Growth Deficiency

Frontiers in Cell and Developmental Biology ◽

10.3389/fcell.2020.587859 ◽

2020 ◽

Vol 8 ◽

Author(s):

Benny S. Latief ◽

Mette A. R. Kuijpers ◽

Adam Stebel ◽

Anne Marie Kuijpers-Jagtman ◽

Piotr S. Fudalej

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Function Analysis ◽

Morphological Variability ◽

Vertical Direction ◽

Principal Component ◽

Canonical Variate ◽

Growth Deficiency ◽

Lateral Cephalograms ◽

Incisor Inclination

In individuals with cleft lip and palate (CLP) an iatrogenic effect of operations on subsequent maxillary growth is well-known. Much less is known about the association between occurrence of CLP and intrinsic growth deficiency of the maxillofacial complex. The aim of this study was to compare morphological variability in subjects with unilateral cleft lip and alveolus/palate and unaffected controls using geometric morphometric methods. The research hypothesis was that if subjects with unrepaired unilateral CLP have intrinsic growth deficiency, the pattern of their craniofacial growth variation may differ from that in unaffected individuals. Lateral cephalograms were available of three groups of the same ethnic background (Proto-Malayid): (a) non-syndromic unrepaired unilateral complete cleft lip, alveolus, and palate (UCLP), N = 66, mean age 24.5 years (b) non-syndromic unrepaired unilateral complete cleft lip and alveolus (UCLA), N = 177, mean age 23.7 years, and (c) NORM (N = 50), mean age 21.2 years without a cleft. Using geometric morphometrics shape variability in groups and shape differences between groups was analyzed. Principal component analysis (PCA) was used to examine shape variability, while differences between groups and sexes were evaluated with canonical variate analysis. Sexual dimorphism was evaluated with discriminant function analysis (DA). Results showed that in comparison to NORM subjects, shape variability in UCLA and UCLP is more pronounced in the antero-posterior than in vertical direction. Pairwise comparisons of the mean shape configurations (NORM vs. UCLA, NORM vs. UCLP, and UCLA vs. UCLP) revealed significant differences between cleft and non-cleft subjects. The first canonical variate (CV1, 68.2% of variance) demonstrated that differences were associated with maxillary shape and/or position and incisor inclination, while in females, the CV1 (69.2% of variance) showed a combination of differences of “maxillary shape and/or position and incisor inclination” and inclination of the cranial base. Shape variability demonstrated considerable differences in subjects with UCLA, UCLP, and NORM. Moreover, in subjects with a cleft, within-sample variability was more pronounced in the antero-posterior direction, while in non-cleft subjects, within-sample variability was more pronounced in the vertical direction. These findings may suggest that subjects with unilateral clefts have intrinsic growth impairment affecting subsequent facial development.

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Description of facial symmetry in patients with unilateral cleft lip and palate using geometric morphometry and computerized tomography

Revista Estomatología ◽

10.25100/re.v22i1.5770 ◽

2017 ◽

Vol 22 (1) ◽

pp. 20-25

Author(s):

Sthepanie Ruiz ◽

Anderson Silva ◽

Mayra Celis ◽

Rocio Ruales ◽

Francined Pardo ◽

...

Keyword(s):

Principal Component Analysis ◽

Thin Plate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Principal Component ◽

Component Analysis ◽

Small Sample ◽

Geometric Methods ◽

Affected Side ◽

Significant Difference

Objective: To describe the maxillary asymmetry in patients with single cleft lip and palate by using morphometrics geometric methods. Materials and Methods: Applied morphometrics geometric methods to analyze images captured from 3D reconstructions of CT scans of 9 patients with unilateral cleft lip and palate, mean age of 13.7 years was used. Tps Dig2 software was used to digitalize 6 maxillary landmarks shaping both the affected and the sides unaffected. TpsPower and TpsPLS to a small sample for relative warps and consensus for superimposition. Thin plate function and asymmetry was used applying ASI-CLIC® package, and the principal component analysis was performed with the PAST software version 2.17.0. Results: There is a statistically significant difference (p<0.05) between the conformation of the maxilla on the affected side compared to unaffected. The study of asymmetry indicated different degrees and differences in the nature of the asymmetry that characterizes different deformities of unilateral cleft lip and palate. The principal component analysis demonstrates both inter-group variability and recognizes two principal components, 39.4%, to the first component and 27.5% to the second component. There is a high correlation between the formation of the unaffected side and affected side conformation r= 0.93847. The thin plate deformation is uniform. The allometry study indicated that there is no association between the shape and size. Conclusions: Morphometry Geometric method is a useful tool for assessing preoperative maxillary conformations in patients with unilateral cleft lip and palate. The side without the cleft is also affected, and is associated with the formation on the side of the cleft. The frontonasal suture is also affected, in a greater proportion than the fronto zigomatic.

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3D-Printed Models of Cleft Lip and Palate for Surgical Training and Patient Education

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665617738998 ◽

2017 ◽

Vol 55 (3) ◽

pp. 323-327 ◽

Cited By ~ 11

Author(s):

Pang-Yun Chou ◽

Rami R. Hallac ◽

Ellen Shih ◽

Jenny Trieu ◽

Anjani Penumatcha ◽

...

Keyword(s):

Patient Education ◽

Cleft Palate ◽

Parental Education ◽

Cleft Lip ◽

Soft Tissues ◽

Cleft Lip And Palate ◽

3D Models ◽

Physical Models ◽

3D Printed ◽

Manufacturing Techniques

Background: Sculpted physical models and castings of the anatomy of cleft lip and palate are used for parent, patient, and trainee education of cleft lip and palate conditions. In this study, we designed a suite of digital 3-dimensional (3D) models of cleft lip and palate anatomy with additive manufacturing techniques for patient education. Methods: CT scans of subjects with isolated cleft palate, unilateral and bilateral cleft lip and palate, and a control were obtained. Soft tissue and bony structures were segmented and reconstructed into digital 3D models. The oral soft tissues overlying the cleft palate were manually molded with silicone putty and scanned using CT to create digital 3D models. These were then combined with the original model to integrate with segmentable soft tissues. Bone and soft tissues were 3D printed in different materials to mimic the rigidity/softness of the relevant anatomy. These models were presented to the parents/patients at our craniofacial clinic. Visual analog scale (VAS) surveys were obtained pertaining to the particular use of the models, to ascertain their value in parental education. Results: A total of 30 parents of children with cleft conditions completed VAS evaluations. The models provided the parents with a better understanding of their child’s condition with an overall evaluation score of 9.35 ± 0.5. Conclusions: We introduce a suite of 3D-printed models of cleft conditions that has a useful role in patient, parental, and allied health education with highly positive feedback.

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Three-Dimensional Evaluation of Facial Asymmetry in Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_1994_031_0116_tdeofa_2.3.co_2 ◽

1994 ◽

Vol 31 (2) ◽

pp. 116-121 ◽

Cited By ~ 19

Author(s):

Frank Ras ◽

Luc L.M.H. Habets ◽

Floris C. Van Ginkel ◽

Birte Prahl-Andersen

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Three Dimensional ◽

Vertical Direction ◽

Facial Asymmetry ◽

Three Dimensions ◽

Control Group ◽

Craniofacial Anomalies ◽

Facial Landmarks ◽

Three Components

The purpose of the present study was to describe facial asymmetry in three dimensions in individuals with an operated complete unilateral cleft lip and palate (UCLP) and in individuals without craniofacial anomalies (controls). Three-dimensional coordinates for 16 bilateral and 10 midsagittal facial landmarks were determined for the UCLP group (N=49) and the control group (N=80) by means of stereophotogrammetry. The total asymmetry was measured and resolved for transverse, vertical, and sagittal components. It can be concluded that all three components are Important in studies on facial asymmetry. Individuals with UCLP show more facial asymmetry in the vertical direction than controls. They demonstrate more facial asymmetry in the region related to the cleft than controls. And, males in general demonstrate more asymmetry of the nose than females.

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Craniofacial Analysis May Indicate Co-Occurrence of Skeletal Malocclusions and Associated Risks in Development of Cleft Lip and Palate

Journal of Developmental Biology ◽

10.3390/jdb8010002 ◽

2020 ◽

Vol 8 (1) ◽

pp. 2 ◽

Cited By ~ 1

Author(s):

Denise K. Liberton ◽

Payal Verma ◽

Konstantinia Almpani ◽

Peter W. Fung ◽

Rashmi Mishra ◽

...

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Morphological Changes ◽

Principal Component ◽

Craniofacial Morphology ◽

Geometric Morphometric ◽

Dentofacial Deformities ◽

Dentofacial Deformity ◽

Maxilla And Mandible ◽

The Impact

Non-syndromic orofacial clefts encompass a range of morphological changes affecting the oral cavity and the craniofacial skeleton, of which the genetic and epigenetic etiologic factors remain largely unknown. The objective of this study is to explore the contribution of underlying dentofacial deformities (also known as skeletal malocclusions) in the craniofacial morphology of non-syndromic cleft lip and palate patients (nsCLP). For that purpose, geometric morphometric analysis was performed using full skull cone beam computed tomography (CBCT) images of patients with nsCLP (n = 30), normocephalic controls (n = 60), as well as to sex- and ethnicity- matched patients with an equivalent dentofacial deformity (n = 30). Our outcome measures were shape differences among the groups quantified via principal component analysis and associated principal component loadings, as well as mean shape differences quantified via a Procrustes distance among groups. According to our results, despite the shape differences among all three groups, the nsCLP group shares many morphological similarities in the maxilla and mandible with the dentofacial deformity group. Therefore, the dentoskeletal phenotype in nsCLP could be the result of the cleft and the coexisting dentofacial deformity and not simply the impact of the cleft.

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