Three-dimensional assessment of facial appearance following surgical repair of unilateral cleft lip and palate.
OBJECTIVE
Objective assessment of postsurgical facial asymmetry can be difficult, but three-dimensional (3D) imaging techniques have made this possible. The objective of this study was to assess residual asymmetry in surgically repaired unilateral cleft lip (UCL) and unilateral cleft lip and palate (UCLP) patients and to compare this with noncleft controls.


METHODS
Retrospective multicohort comparative study.


METHODS
Fifty-one 10-year-old children with surgically managed UCLP and 44 children with UCL were compared with a control group of 68 ten-year-olds. The 3D facial models at rest and with maximum smile were created using a 3D imaging system. Asymmetry scores were produced using both anatomical landmarks and a novel method of facial curve analysis.


RESULTS
Asymmetry for the whole face was significantly higher in both cleft groups compared with controls (P < .001). UCLP asymmetry was higher than UCL (P < .001). In cleft patients, the upper lip and nasal rim were the most asymmetric (P < .001 to .05). Control subjects also displayed a degree of facial asymmetry. Maximum smile did not significantly affect the symmetry of the whole face, but it increased asymmetry of the vermillion border and nasal rim in all three groups (P < .001).


CONCLUSIONS
Despite surgical intervention at an early age, asymmetry remains significant in cleft patients at 10 years of age. Three-dimensional imaging is a noninvasive objective assessment tool that identifies specific areas of the face responsible for asymmetry. Facial curve analysis describes the face more comprehensively and characterizes soft tissue contours.
Aileen
A
Bell
Tsz-Wai Rachel
TW
Lo
Denise
D
Brown
Adrian W
AW
Bowman
J Paul
JP
Siebert
David R
DR
Simmons
Declan T
DT
Millett
Ashraf F
AF
Ayoub
D059925:Anatomic Landmarks; D002648:Child; D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D005146:Facial Asymmetry / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D010781:Photography; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012606:Scotland
3D imaging; cleft lip + palate; facial asymmetry; surgical outcomes