Three-dimensional nasal morphology in cleft lip and palate operated adult patients.

Nasal morphology was assessed three-dimensionally in 18 cleft lip and palate operated patients aged 19 to 27 years, and in 161 sex- and age-matched control subjects. Comparisons were performed by Student t and Watson-Williams' tests. No differences were found in nasal volume or surface. Nasal width, alar base width, and inferior width of the nostrils were significantly larger in male patients than in the reference men. The nasal bridge was shorter. Similar differences were found in the female patients. In addition, the right nostril was larger and the nasal height shorter. In men, the nasolabial and the nasal tip angles were smaller in the patients than in the reference subjects, whereas the facial convexity angle was larger in the patients. In conclusion, the nose of adult operated cleft lip and palate patients differed from that of normal control subjects. Surgical corrections of the cleft lip and palate failed to provide a completely normal appearance. The methods might be used to indicate where additional procedures might be performed to approximate a reference population.

A quantitative three-dimensional assessment of soft tissue facial asymmetry of cleft lip and palate adult patients.

The three-dimensional coordinates of 23 selected soft-tissue facial landmarks were digitized on 18 cleft lip and palate (CLP) white patients (11 male and 7 female patients aged 19-27 years) and 161 healthy controls (73 female and 89 male subjects aged 18-30 years) by an electromagnetic instrument. Facial asymmetry was quantified by detecting a plane of symmetry and the centers of gravity (CG) of the right and left hemifaces and by calculating the distance between the two CG (distance from symmetry [DFS]). Both absolute (millimeters) and percentage (of the nasion center of gravity distance) DFS was obtained. The asymmetry of single landmarks was also quantified. Overall, asymmetry in operated CLP patients appeared only moderately larger than that measured in the healthy reference population, with the largest value being only 5% larger than the maximum normal asymmetry. Female patients had a somewhat larger lateral asymmetry than male patients, and unilateral CLP patients (particularly the men) were more asymmetrical than bilateral CLP patients. Pronasale and subnasale landmarks were asymmetrical in 8 patients, whereas endocanthion, zygion, cheilion, and gonion landmarks were symmetrical in all patients. In conclusion, the facial soft-tissue structures of CLP patients operated on as adults were only moderately more asymmetrical than those measured in a reference group of the same age, sex, and ethnicity.

A quantitative three-dimensional assessment of abnormal variations in facial soft tissues of adult patients with cleft lip and palate.

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.

Three-dimensional lip morphometry in adults operated on for cleft lip and palate.

Measurements were taken from 18 patients operated on for cleft lip and palate, aged 19 to 27 years, and 162 control subjects matched for sex, age, and ethnic group. Nine soft-tissue landmarks on the lips were digitized by a three-dimensional electromagnetic instrument. From the landmarks, several linear distances (mouth width, philtrum width, vermilion height of upper and lower lip, total vermilion height, total lip height), the interlabial angle, and some areas (vermilion of upper lip, vermilion of lower lip, total vermilion) and volumes (upper lip volume, lower lip volume, total lip volume) were calculated. Patient and reference data were compared by t tests and Watson-Williams tests. In the men, significant differences (p < 0.05) were found in width of the philtrum, height and area of the vermilion part of the upper lip, and total vermilion height and area (all larger in male patients than in controls). In the women, significant differences were found in the height and area of the vermilion part of the upper lip (larger in female patients than in controls), and in the height and area of the vermilion part of the lower lip (smaller in patients than in controls). In both sexes, the interlabial angle was smaller than in the reference population. In conclusion, the upper lip of adult patients operated on for cleft lip and palate differed from that of healthy controls of the same age, sex, and ethnic group. Surgical correction of cleft lip and palate failed to provide a completely normal appearance. The analysis pointed out those parts of the lips and mouth (in particular, the vermilion part of the upper lip) that differed the most from the norm. The method may be used to indicate to the surgeon and patient where additional procedures might be performed to approximate the morphologic characteristics of a reference population.