title: Soft-tissue profile growth in patients with repaired complete unilateral cleft lip and palate: A cephalometric comparison with normal controls at ages 7, 11, and 18 years.
abstract: BACKGROUND
  In this retrospective longitudinal study, we aimed to study differences in the soft-tissue profiles in growing children with clefts in comparison with controls through the period of facial growth from 7 to 18 years.
  
  
  METHODS
  Lateral cephalometric measurements made at 7 years (T1), 11.1 years (T2), and 17.9 years (T3) of age of 70 white children (35 boys, 35 girls) with complete unilateral cleft lip and palate (UCLP) who received primary lip and palate repair surgeries at The Hospital for Sick Children, Toronto, were compared with those of a control group of similar ages, sexes, and racial backgrounds, and having skeletal Class I facial growth, selected from the Burlington Growth Study. None of the included subjects had received any surgeries other than the primary lip and palate repairs, and none had undergone nasal septum surgery or nasal molding during infancy. Between-group comparisons were made at each time point using generalized linear models adjusted for age and sex effects. Longitudinal comparisons across all time points were conducted using the mixed model approach, adjusting for these effects and their interactions with time.
  
  
  RESULTS
  Bimaxillary retrognathism, progressive maxillary retrognathism, and increasing lower anterior face height with downward and backward growth rotation of the mandible in the UCLP group were seen. Unlike the hard-tissue face height ratio, their soft-tissue face height ratio was not affected. The upper lips in the UCLP group were shorter by 1.81 mm at T2 (P <0.001) and by 1.16 mm at T3 (P = 0.018), whereas their lower lips were 2.21 mm longer at T3 (P = 0.003). A reduced upper lip to lower lip length ratio at T2 and T3 (P <0.001) resulted. Their upper lips were relatively retruded by 1.44 mm at T1, 1.66 mm at T2, and 1.86 mm at T3 (all, P <0.001), and their lower lips were relatively protruded by 1.07 mm at T1 (P = 0.003), 1.40 mm at T2 (P <0.001), and 1.62 mm at T3 (P <0.001). Nose depths in the UCLP group were shallower by at least 1 mm from T1 to T3, and columellar length was shorter by almost 2 mm (all, P <0.001). Their columellae and nose tips rotated downward with growth, with the most significant rotations experienced from T2 to T3, and progressive reductions in their soft-tissue profile convexity were seen from T1 to T3 (P <0.001).
  
  
  CONCLUSIONS
  Key attributes of the imbalance in the soft-tissue profile in children with repaired UCLP were identified in the lip and nose regions. Although many profile differences were visible as early as 7 years of age, they became more apparent by 11 years of age and increased in severity thereafter. The short upper lip combined with a long lower lip resulted in the characteristic lip length imbalance, whereas the progressively retruding upper lip and protruding lower lip led to developing a step relationship in the sagittal lip profile during the adolescent growth period. Their columellae and nose tips rotated downward during this time.
authors.affiliation: Research associate, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; former clinical orthodontic fellow, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Iris
authors.initials: I
authors.lastname: Moreira
authors.affiliation: Associate professor, Discipline of Orthodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; staff orthodontist, Hospital for Sick Children, Toronto, Ontario, Canada. Electronic address: sunjaysuri@hotmail.com.
authors.forename: Sunjay
authors.initials: S
authors.lastname: Suri
authors.affiliation: Professor, Discipline of Orthodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; staff orthodontist, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Bruce
authors.initials: B
authors.lastname: Ross
authors.affiliation: Associate professor and head, Discipline of Orthodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; head, Division of Orthodontics, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Bryan
authors.initials: B
authors.lastname: Tompson
authors.affiliation: Medical director, Cleft Lip and Palate Program, Hospital for Sick Children, Toronto, Ontario, Canada; associate professor, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Fisher
authors.affiliation: Professor and head, Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Canada Research Chair in Statistical Methods for Health Care, Toronto, Ontario, Canada.
authors.forename: Wendy
authors.initials: W
authors.lastname: Lou
mesh_terms: D000293:Adolescent; D002508:Cephalometry / Q000379:methods*; D002648:Child; D002971:Cleft Lip / Q000503:physiopathology / Q000601:surgery*; D002972:Cleft Palate / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007180:Incisor / Q000473:pathology; D008046:Lip / Q000473:pathology; D008137:Longitudinal Studies; D008297:Male; D008334:Mandible / Q000254:growth & development / Q000473:pathology; D008437:Maxilla / Q000002:abnormalities; D008445:Maxillofacial Development / Q000502:physiology*; D009666:Nose / Q000473:pathology; D019651:Plastic Surgery Procedures / Q000379:methods; D063173:Retrognathia / Q000175:diagnosis; D012189:Retrospective Studies; D012399:Rotation; D019291:Skull Base / Q000473:pathology; D014716:Vertical Dimension