Etiology of Cleft Lip Lower Lip Deformity: Use of an Objective Analysis to Measure Severity

Abstract

Objective:

Measure lower lip thickness and eversion in patients with cleft lip and palate (CLP) and maxillary hypoplasia. The specific aims were to (1) compare lower lip thickness/eversion in patients with CLP to noncleft controls with maxillary hypoplasia, (2) determine differences between patients with unilateral CLP (UCLP) and bilateral CLP (BCLP), and (3) document changes in the lower lip that occur with Le Fort I advancement.

Design:

Retrospective case–control study.

Setting:

Tertiary care center.

Patients/Participants:

Patients with available pre- and postoperative CT scans and 2D lateral photographs who had a Le Fort I advancement between 2009 and 2017. There were 32 patients with CLP (17 females; mean age 17.7 ± 1.9 years) and 33 noncleft controls (21 females; mean age 18.8 ± 2.6 years).

Main Outcome Measures:

Lower lip thickness and eversion.

Results:

Patients with CLP and maxillary hypoplasia have a significantly thicker lower lip (P = .019) and outward rotation of the vermilion border (P = .003) compared to noncleft controls. The lower lip was significantly thicker in patients with BCLP than in those with UCLP (P = .035). Lower lip thickness and rotation did not change after maxillary advancement.

Conclusions:

Patients with CLP and maxillary hypoplasia have a thicker and more everted lower lip than noncleft controls. Patients with BCLP have a significantly thicker lower lip than those with UCLP. Strain of the lower lip musculature appears to be an important contributor to the development of the cleft lip lower lip deformity.

Keywords

lower lip thickness eversion maxillary hypoplasia

Get full access to this article

View all access options for this article.

References

Capelozza

Normando

da Silva Filho

. Isolated influences of lip and palate surgery on facial growth: comparison of operated and unoperated male adults with UCLP. Cleft Palate Craniofac J. 1996;33(1):51–56.

Carvajal

Miralles

Cauvi

Berger

Carvajal

Bull

. Superior orbicularis oris muscle activity in children with and without cleft lip and palate. Cleft Palate Craniofac J. 1992;29(1):32–36; discussion 6-7.

Cohen

Corrigan

Wilmot

Trotman

. Cumulative operative procedures in patients aged 14 years and older with unilateral or bilateral cleft lip and palate. Plast Reconstr Surg. 1995;96(2):267–271.

Dado

Kernahan

. Anatomy of the orbicularis oris muscle in incomplete unilateral cleft lip based on histological examination. Ann Plast Surg. 1985;15(2):90–98.

DeLuke

Marchand

Robles

Fox

. Facial growth and the need for orthognathic surgery after cleft palate repair: literature review and report of 28 cases. J Oral Maxillofac Surg. 1997;55(7):694–697; discussion 7-8.

Duffy

Noar

Evans

Sanders

. Three-dimensional analysis of the child cleft face. Cleft Palate Craniofac J. 2000;37(2):137–144.

Genaro

Trindade Junior

Trindade

. Electromyographic analysis of lip muscle function in operated cleft subjects. Cleft Palate Craniofac J. 1994;31(1):56–60.

Good

Mulliken

Padwa

. Frequency of Le Fort I osteotomy after repaired cleft lip and palate or cleft palate. Cleft Palate Craniofac J. 2007;44(4):396–401.

Han

Suzuki

Tashiro

. Longitudinal study of craniofacial growth in subjects with cleft lip and palate: from cheiloplasty to 8 years of age. Cleft Palate Craniofac J. 1995;32(2):156–166.

10.

Jacobson

. The “Wits” appraisal of jaw disharmony. Am J Orthod. 1975;67(2):125–138.

11.

Liao

Huang

Noordhoff

. Comparison of craniofacial morphology in patients with bilateral complete cleft of primary versus secondary palate. Cleft Palate Craniofac J. 2002;39(3):353–356.

12.

Lundstrom

. The Frankfort horizontal as a basis for cephalometric analysis. Am J Orthod Dentofacial Orthop. 1995;107(5):537–540.

13.

Madsen

Sampson

Townsend

. Craniofacial reference plane variation and natural head position. Eur J Orthod. 2008;30(5):532–540.

14.

Mars

Houston

. A preliminary study of facial growth and morphology in unoperated male unilateral cleft lip and palate subjects over 13 years of age. Cleft Palate J. 1990;27(1):7–10.

15.

Mooney

Siegel

Kimes

Todhunter

. Development of the orbicularis oris muscle in normal and cleft lip and palate human fetuses using three-dimensional computer reconstruction. Plast Reconstr Surg. 1988;81(3):336–345.

16.

Park

Koh

Choi

. Lower lip deformity in patients with cleft and non-cleft Class III malocclusion before and after orthognathic surgery. J Craniomaxillofac Surg. 2015;43(8):1638–1642.

17.

Pensler

Mulliken

. The cleft lip lower-lip deformity. Plast Reconstr Surg. 1988;82(4):602–610.

18.

Ravera

Miralles

Santander

Valenzuela

Villaneuva

Zuniga

. Comparative study between children with and without cleft lip and cleft palate, part 2: electromyographic analysis. Cleft Palate Craniofac J. 2000;37(3):286–291.

19.

Rogers

Mooney

Smith

, et al. Comparative microanatomy of the orbicularis oris muscle between chimpanzees and humans: evolutionary divergence of lip function. J Anat. 2009;214(1):36–44.

20.

Rosenstein

Kernahan

Dado

Grasseschi

Griffith

. Orthognathic surgery in cleft patients treated by early bone grafting. Plast Reconstr Surg. 1991;87(5):835–892; discussion 40-2.

21.

Ross

. Treatment variables affecting facial growth in complete unilateral cleft lip and palate. Cleft Palate J. 1987;24(1):5–77.

22.

Szyszka-Sommerfeld

Wozniak

Matthews-Brzozowska

Kawala

Mikulewicz

. Electromyographic analysis of superior orbicularis oris muscle function in children surgically treated for unilateral complete cleft lip and palate. J Craniomaxillofac Surg. 2017;45(9):1547–1551.

23.

Zhu

Senewiratne

Pigott

. Lip posture and mouth width in children with unilateral cleft lip. Br J Plast Surg. 1994;47(5):301–305.