To visualize and quantitatively analyze facial surface asymmetry following primary cleft lip repair in patients with unilateral cleft lip and palate (UCLP) and to compare this with noncleft controls.
Design:
Retrospective comparative study.
Patients:
Twenty-two patients with complete UCLP who underwent primary lip repair from 2009 to 2013 were enrolled in this study. The preserved 3-dimensional (3D) data of 23 healthy Japanese participants with the same age were used as controls.
Interventions:
All patients had received primary labioplasty in accordance with Cronin triangular flap method with orbicular oris muscle reconstruction.
Main Outcome Measures:
Shadow and zebra images established from moiré images, which were reconstructed from 3D facial data using stereophotogrammetry, were bisected and reversed by the symmetry axes (the middle line of the face). The discrepancies of the gravity and density between cleft and noncleft sides in 2 regions of interest, facial and lip areas, were then calculated and compared with those of healthy participants.
Results:
In the UCLP group, the mean discrepancies of gravity on shadow and zebra images were 1.76 ± 0.70 and 2.63 ± 1.72 pixels, respectively, in the facial area and 1.31 ± 0.36 and 3.83 ± 2.08 pixels, respectively, in the lip area. There was a significant difference in the mean discrepancies of gravity and density on zebra images in the lip area between the UCLP and control groups.
Conclusions:
Our image analysis of digital facial surface asymmetry in patients with UCLP provides visual and quantitative information, and it may contribute to improvements in muscle reconstruction on cleft lip repair.
AbramoACPovedanoA. Orbicularis oris muscle: a double-breasted suture for its repair in the unilateral cleft lip. Ann Plast Surg. 1991;27(5):398–403.
2.
Al-RudainyDJuXMehendaleFAyoubA. Assessment of facial asymmetry before and after the surgical repair of cleft lip in unilateral cleft lip and palate cases. Int J Oral Maxillofac Surg. 2017;47(3):411–419.
BellALoTWRBrownDBowmwnAWSiebertPSimmonsDRMillettDTAyobAF. Three-dimensional assessment of facial appearance following surgical repair of unilateral cleft lip and palate. Cleft Palate Craniofac Surg. 2014;51(4):462–471.
5.
CroninTD. A modification of the Tennison-type lip repair. Cleft Palate J. 1966;3:376–382.
6.
CuttingCBMcCathyJGKarronDB. Three-dimensional input of body surface data using a laser light scanner. Ann Plast Surg. 1988;21(1):38–45.
7.
DadoDV. Analysis of the lengthening effect of the muscle repair in functional cleft lip repair. Plast Reconstr Surg. 1988;82(4):594–601.
8.
DelaireJ. Theoretical principles and technique of functional closure of the lip and nasal aperture. J Maxillofac Surg. 1978;6(2):109–116.
9.
FarkasLGHajnisKPosnickJC. Anthropometric and anthroposcopic findings of the nasal and facial region in cleft patients before and after primary lip and palate repair. Cleft Palate Craniofac J. 1993;30(1):1–12.
FriedeHLiljaJJohnsonB. Lip-nose morphology and symmetry in unilateral cleft lip and palate patients following a two-stage lip closure. Scand J Plast Reconstr Surg. 1980;14(1):55–64.
12.
HermannNVDarvannTALarsenPLindholmPAndersenMKreiborgS. A pilot study on the influence of facial expression on measurement in three-dimensional digital surfaces on the face in infants with cleft lip and palate. Cleft Palate Craniofac J. 2016;53(1):3–15.
13.
IshikawaSKosakaHKatoKOtsukaY. A method of analyzing a shape with potential symmetry and its application to detecting spinal deformity. Comput Vis Virtual Real Robot Med. 1995;465–470.
14.
KawaiTNatsumeNShibataHYamamotoT. Three-dimensional analysis of facial morphology using moiré stripes. Part I. Method. Int J Oral Maxillofac Surg. 1990;19(6):356–358.
15.
KernahanDSBauerB. Functional cleft lip repair: a sequential layered closure with orbicularis muscle realignment. Plast Reconstr Surg. 1982;72(4):459–466.
16.
KimHSIshikawaSOtsukaYShimizuHNakadaYShinomiyaT. Discrimination of spinal deformity employing discriminant analysis on the moiré images. In: Proceeding of the International Conference on Control, Automation and Systems; 2003, October 22:1990–1993.
17.
KimHSIshikawaSOhtsukaYShimizuHShinomiyaTViergeverM. Automatic scoliosis detection based on local centroids evaluation on moiré topographic images of human backs. IEEE Trans Med Imaging. 2001;20(12):1314–1320.
MatsunagaKNishiharaKMasaakiMOhishiMNakamuraSNakamuraN. Upward advancement of the nasolabial component prevents postoperative long lip following primary unilateral cleft lip repair. Cleft Palate Craniofac J. 2016;53(3):e71–e80.
20.
MillardDR. Anatomy of the unilateral cleft lip. Muscle alignment. In: Cleft Craft. The Evolution of Its Surgery. I. The Unilateral Deformity. Boston, MA: Little, Brown; 1976:25–31, 286–295.
21.
MinovicPIshikawaSKatoK. Three-dimensional symmetry identification. Part I: Theory. Memoir of the Kyushu Institute of Technology. 1992;21:1–16.
22.
NakamuraNSasaguriMNozoeENishiharaKHasegawaHNakamuraS. Postoperative nasal forms after presurgical nasoalveolar molding followed by medial-upward advancement of the nasolabial components with vestibular expansion for children with unilateral complete cleft lip and palate. J Oral Maxillofac Surg. 2009;67(10):2222–2231.
23.
NakamuraNOkawachiTNozoeE.NishiharaKMatsunagaK. Three dimensional analyses of nasal forms after secondary treatment of bilateral cleft lip-nose deformity in comparison to those of healthy young adult. J Oral Maxillofac Surg. 2011;69(11):e469–e481.
24.
NemotoT. Morphological studies on the face with unilateral cleft lip—an application of the computerized three-dimensional analysis of Moiré Topography [in Japanese]. Jpn J Oral Surgery. 1979;25(4):798–814.
25.
NicolauPJ. The orbicularis oris muscle: a functional approach to its repair in the cleft lip. Br J Plast Surg. 1983;36(2):141–153.
26.
OkawachiTNozoeENishiharaKHiraharaNNakamuraN. Three dimensional analyses of nasal forms following secondary correction of unilateral cleft lip nose deformity. J Oral Maxillofac Surg. 2011;69(2):322–332.
27.
ParkCGHaB. The importance of accurate repair of the orbicularis oris muscle in the correction of unilateral cleft lip. Plast Reconstr Surg. 1995;96(4):780–788.
28.
RandalP. A triangular flap operation for the primary repair of unilateral clefts of the lip. Plast Reconstr Surg Transplant Bull. 1959;23(4):331–347.
29.
RandalPWhitakerLALaRossaD. The importance of muscle reconstruction in primary and secondary cleft lip repair. Plast Reconstr Surg. 1974;54(3):316–323.
TajimaS. The importance of the muscle nasalis and the use of cleft margin flap in the repair of complete unilateral cleft lip. J Maxillofac Surg. 1983;11(2):64–70.
32.
WuJBirgfeldCEvansKMagaMMorrisonCSaltzmanBShapiroLTseR. Measuring symmetry in children with unrepaired cleft lip: defining a standard for the three-dimensional midfacial reference plane. Cleft Palate Craniofac Surg. 2016a;53(6):695–704.
33.
WuJLiangSShapiroLTseR. Measuring symmetry in children with cleft lip. Part 2. Quantification of nasolabial symmetry before and after cleft lip repair. Cleft Palate Craniofac Surg. 2016b;53(6):6705–6713.
34.
YamadaTMoriYMinamiKMishimaKTsukamotoY. Three-dimensional analysis of facial morphology in normal Japanese children as control data for cleft surgery. Cleft Palate Craniofac Surg. 2002;39(5):517–526.
