Bilateral cleft lip and palate: A morphometric analysis of facial skeletal form using cone beam computed tomography

Abstract

Bilateral cleft lip and palate (BCLP) is caused by a lack of merging of maxillary and nasal facial prominences during development and morphogenesis. BCLP is associated with congenital defects of the oronasal facial region that can impair ingestion, mastication, speech, and dentofacial development. Using cone beam computed tomography (CBCT) images, 7- to 18-year old individuals born with BCLP (n = 15) and age- and sex-matched controls (n = 15) were retrospectively assessed. Coordinate values of three-dimensional facial skeletal anatomical landmarks (n = 32) were measured from each CBCT image. Data were evaluated using principal coordinates analysis (PCOORD) and Euclidean Distance Matrix Analysis (EDMA). PCOORD axes 1-3 explain approximately 45% of the morphological variation between samples, and specific patterns of morphological differences were associated with each axis. Approximately, 30% of facial skeletal measures significantly differ by confidence interval testing (α = 0.10) between samples. While significant form differences occur across the facial skeleton, strong patterns of differences are localized to the lateral and superioinferior aspects of the nasal aperture. In conclusion, the BCLP deformity significantly alters facial skeletal morphology of the midface and oronasal regions of the face, but morphological differences were also found in the upper facial skeleton and to a lesser extent, the lower facial skeleton. This pattern of strong differences in the oronasal region of the facial skeleton combined with differences across the rest of the facial complex underscores the idea that bones of the craniofacial skeleton are integrated.

Breaking Symmetry: A Quantitative Analysis of Facial Skeleton Disharmony in Children Born with Bilateral Cleft Lip and Palate

“…Typically, the clefts on each side of the face have unequal severity, which can contribute to the development of facial asymmetry. Congenital facial defects resulting from BCLP can impair ingestion, mastication, speech, and dentofacial development (Starbuck et al ., ; Starbuck et al ., ). Facial structures of individuals with BCLP typically include a broader nose, more protrusive nasal bridge, extended soft tissue alar rims, more inferiorly positioned and retrusive nasal dome, flatter zygomatic area and cheeks, and a flatter and more retrusive upper lip and mid‐facial region, with structures often being more protrusive and asymmetric on the left side of the face (Bugaighis et al ., ; Bugaighis et al ., , ).…”

“…CLP may alter patterns of craniofacial growth and is typically addressed through surgical intervention to restore lip and mouth function and improve aesthetics. Despite efforts of surgeons, persons with bilateral cleft lip and palate (BCLP) display facial form differences related to this deformity (Starbuck et al ., , ). Results from prior studies of BCLP provided tangential evidence of facial asymmetry (Starbuck et al ., , ), but this phenomenon is seldom measured.…”

A morphometric analysis of developmental instability in children born with unilateral cleft lip and palate

“…Using Dolphin Imaging software (v11.5; Chatsworth, CA), anatomical landmarks (Fig. , Table ) were identified on CBCT images of all individuals on two separate occasions with at least 24 hr in between measurements of individuals to avoid memory bias (Starbuck et al, , , ). Coordinate values of both trials from 10 individuals were compared to eliminate the possibility of gross errors (e.g., swapping sides, altering order) and to assess measurement error and repeatability.…”

“…Cleft lip and palate pathogenesis is associated with changes in patterns of growth of the craniofacial skeleton that are typically addressed through surgical intervention. Despite surgeries, individuals with unilateral and bilateral CLP display facial form differences related to this congenital defect (Starbuck et al, , ). Previous investigations of unilateral CLP suggest that faces of children born with CLP also express some degree of asymmetry, although this phenomenon is rarely quantified (Kane et al, ).…”

Disruption of symmetry: A quantitative assessment of facial skeleton anatomy in children born with unilateral cleft lip and palate

“…Despite surgeries, individuals with unilateral and bilateral CLP display facial form differences related to this defect (Starbuck et al, , , ). Results from previous investigations of CLP suggest that faces of children born with CLP also express some degree of asymmetry (Starbuck et al, , ), although this phenomenon is rarely quantified.…”