Korean J Orthod.  2013 Jun;43(3):113-119. 10.4041/kjod.2013.43.3.113.

Three-dimensional evaluation of midfacial asymmetry in patients with nonsyndromic unilateral cleft lip and palate by cone-beam computed tomography

Affiliations
  • 1Department of Orthodontics, Pusan National University Dental Hospital, Yangsan, Korea.
  • 2Department of Orthodontics, School of Dentistry, Pusan National University, Busan, Korea. kimyongil@pusan.ac.kr
  • 3Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.

Abstract


OBJECTIVE
To compare three-dimensionally the midfacial hard- and soft-tissue asymmetries between the affected and the unaffected sides and determine the relationship between the hard tissue and the overlying soft tissue in patients with nonsyndromic complete unilateral cleft lip and palate (UCLP) by cone-beam computed tomography (CBCT) analysis.
METHODS
The maxillofacial regions of 26 adults (18 men, 8 women) with nonsyndromic UCLP were scanned by CBCT and reconstructed by three-dimensional dental imaging. The frontal-view midfacial analysis was based on a 3 x 3 grid of vertical and horizontal lines and their intersecting points. Two additional points were used for assessing the dentoalveolar area. Linear and surface measurements from three reference planes (Basion-perpendicular, midsagittal reference, and Frankfurt horizontal planes) to the intersecting points were used to evaluate the anteroposterior, transverse, and vertical asymmetries as well as convexity or concavity.
RESULTS
Anteroposteriorly, the soft tissue in the nasolabial and dentoalveolar regions was significantly thicker and positioned more anteriorly on the affected side than on the unaffected side (p < 0.05). The hard tissue in the dentoalveolar region was significantly retruded on the affected side compared with the unaffected side (p < 0.05). The other midfacial regions showed no significant differences.
CONCLUSIONS
With the exception of the nasolabial and dentoalveolar regions, no distinctive midfacial hard- and soft-tissue asymmetries exist between the affected and the unaffected sides in patients with nonsyndromic UCLP.

Keyword

Computed tomography; Cleft lip and palate; Asymmetry; Soft tissue

MeSH Terms

Adult
Cleft Lip
Cone-Beam Computed Tomography
Humans
Male
Palate

Figure

  • Figure 1 Planes parallel to the reference planes and their intersecting points. SH, Superior horizontal; MH, middle horizontal; IH, inferior horizontal; LS, lateral sagittal; MS, middle sagittal; IS, inner sagittal. See Table 1 for the definitions.

  • Figure 2 Linear and surface measurements. A, Distance between the Ba-perpendicular plane and the corresponding hard- and soft-tissue points. B, Distance between the midsagittal reference (MSR) plane and the inner sagittal (IS) and lateral sagittal (LS) planes as well as the most lateral soft-tissue point on each of the vertical lines. C, Distance between the Frankfurt horizontal (FH) plane and the superior horizontal (SH) and inferior horizontal (IH) planes. D, Surface measurements between IS plane and line from inner measurement point to lateral measurement point. See Table 1 for the abbreviations.


Cited by  2 articles

Three-dimensional evaluation of the correlation between lip canting and craniofacial planes
Jun-Young Kim, Hee-Keun Park, Seung-Woo Shin, Jin Hoo Park, Hwi-Dong Jung, Young-Soo Jung
Korean J Orthod. 2020;50(4):258-267.    doi: 10.4041/kjod.2020.50.4.258.

Hard- and soft-tissue profiles of the midface region in patients with skeletal Class III malocclusion using cone-beam computed tomography multiplanar-reconstructed image analysis
Bomi Kim, Hyung-Chul Lee, Seong-Hun Kim, Yongil Kim, Woosung Son, Seong Sik Kim
Korean J Orthod. 2018;48(3):143-152.    doi: 10.4041/kjod.2018.48.3.143.


Reference

1. Mossey PA, Little J, Munger RG, Dixon MJ, Shaw WC. Cleft lip and palate. Lancet. 2009. 374:1773–1785.
Article
2. Baik HS, Keem JH, Kim DJ. The prevalence of cleft lip and/or cleft palate in Korean male adult. Korean J Orthod. 2001. 31:63–69.
3. Li J, Shi B, Liu K, Zheng Q. A preliminary study on the hard-soft tissue relationships among unoperated secondary unilateral cleft nose deformities. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012. 113:300–307.
Article
4. Atherton JD. Morphology of facial bones in skulls with unoperated unilateral cleft palate. Cleft Palate J. 1967. 4:18–30.
5. Joos U. Skeletal growth after muscular reconstruction for cleft lip, alveolus and palate. Br J Oral Maxillofac Surg. 1995. 33:139–144.
Article
6. Stauber I, Vairaktaris E, Holst A, Schuster M, Hirschfelder U, Neukam FW, et al. Three-dimensional analysis of facial symmetry in cleft lip and palate patients using optical surface data. J Orofac Orthop. 2008. 69:268–282.
Article
7. Meyer-Marcotty P, Alpers GW, Gerdes AB, Stellzig-Eisenhauer A. Impact of facial asymmetry in visual perception: a 3-dimensional data analysis. Am J Orthod Dentofacial Orthop. 2010. 137:168.e1–168.e8.
Article
8. Son WS, Kim MK. Facial asymmetry of unilateral cleft lip and palate patients. Korean J Orthod. 1995. 25:13–18.
9. Mølsted K, Dahl E. Asymmetry of the maxilla in children with complete unilateral cleft lip and palate. Cleft Palate J. 1990. 27:184–190.
Article
10. Mølsted K, Kjaer I, Dahl E. Cranial base in newborns with complete cleft lip and palate: radiographic study. Cleft Palate Craniofac J. 1995. 32:199–205.
Article
11. Ras F, Habets LL, van Ginkel FC, Prahl-Andersen B. Three-dimensional evaluation of facial asymmetry in cleft lip and palate. Cleft Palate Craniofac J. 1994. 31:116–121.
Article
12. Broder HL, Smith FB, Strauss RP. Effects of visible and invisible orofacial defects on self-perception and adjustment across developmental eras and gender. Cleft Palate Craniofac J. 1994. 31:429–436.
Article
13. Lee LW, Chen SH, Yu CC, Lo LJ, Lee SR, Chen YR. Stigma, body image, and quality of life in women seeking orthognathic surgery. Plast Reconstr Surg. 2007. 120:225–231.
Article
14. Laspos CP, Kyrkanides S, Tallents RH, Moss ME, Subtelny JD. Mandibular asymmetry in noncleft and unilateral cleft lip and palate individuals. Cleft Palate Craniofac J. 1997. 34:410–416.
Article
15. Smahel Z, Brejcha M. Differences in craniofacial morphology between complete and incomplete unilateral cleft lip and palate in adults. Cleft Palate J. 1983. 20:113–127.
16. Kurt G, Bayram M, Uysal T, Ozer M. Mandibular asymmetry in cleft lip and palate patients. Eur J Orthod. 2010. 32:19–23.
Article
17. Suri S, Utreja A, Khandelwal N, Mago SK. Craniofacial computerized tomography analysis of the midface of patients with repaired complete unilateral cleft lip and palate. Am J Orthod Dentofacial Orthop. 2008. 134:418–429.
Article
18. Kim YI, Kim JR, Park SB. Three-dimensional analysis of midfacial soft tissue changes according to maxillary superior movement after horizontal osteotomy of the maxilla. J Craniofac Surg. 2010. 21:1587–1590.
Article
19. de Moraes ME, Hollender LG, Chen CS, Moraes LC, Balducci I. Evaluating craniofacial asymmetry with digital cephalometric images and cone-beam computed tomography. Am J Orthod Dentofacial Orthop. 2011. 139:e523–e531.
Article
20. Hwang HS, Hwang CH, Lee KH, Kang BC. Maxillofacial 3-dimensional image analysis for the diagnosis of facial asymmetry. Am J Orthod Dentofacial Orthop. 2006. 130:779–785.
Article
21. Kyrkanides S, Klambani M, Subtelny JD. Cranial base and facial skeleton asymmetries in individuals with unilateral cleft lip and palate. Cleft Palate Craniofac J. 2000. 37:556–561.
Article
22. Zemann W, Santler G, Kärcher H. Analysis of midface asymmetry in patients with cleft lip, alveolus and palate at the age of 3 months using 3D-COSMOS measuring system. J Craniomaxillofac Surg. 2002. 30:148–152.
Article
23. Kim YH, Sato K, Mitani H, Shimizu Y, Kikuchi M. Asymmetry of the sphenoid bone and its suitability as a reference for analyzing craniofacial asymmetry. Am J Orthod Dentofacial Orthop. 2003. 124:656–662.
Article
24. Suzuki H, Yamaguchi T, Furukawa M. Rhinologic computed tomographic evaluation in patients with cleft lip and palate. Arch Otolaryngol Head Neck Surg. 1999. 125:1000–1004.
Article
25. Kolbenstvedt A, Aaløkken TM, Arctander K, Johannessen S. CT appearances of unilateral cleft palate 20 years after bone graft surgery. Acta Radiol. 2002. 43:567–570.
Article
26. Breitsprecher L, Fanghänel J, Metelmann HR, Mlynski G, Würfel F, Freise K, et al. The influence of the muscles of facial expression on the development of the midface and the nose in cleft lip and palate patients. A reflection of functional anatomy, facial esthetics and physiology of the nose. Ann Anat. 1999. 181:19–25.
Article
27. Markus AF, Precious DS. Effect of primary surgery for cleft lip and palate on mid-facial growth. Br J Oral Maxillofac Surg. 1997. 35:6–10.
Article
28. Markus AF, Delaire J, Smith WP. Facial balance in cleft lip and palate. II. Cleft lip and palate and secondary deformities. Br J Oral Maxillofac Surg. 1992. 30:296–304.
Article
29. Sade Hoefert C, Bacher M, Herberts T, Krimmel M, Reinert S, Göz G. 3D soft tissue changes in facial morphology in patients with cleft lip and palate and class III mal occlusion under therapy with rapid maxillary expansion and delaire facemask. J Orofac Orthop. 2010. 71:136–151.
Article
30. Carstens MH. Functional matrix cleft repair: principles and techniques. Clin Plast Surg. 2004. 31:159–189.
Article
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