Facial Characterization of Infants with Cleft Lip and Palate Using a Three-Dimensional Capture Technique

Abstract

Objective

To characterize the soft tissue features of infants with unilateral cleft lip (UCL) and unilateral complete cleft lip and palate (UCLP) prior to primary surgery and compare with noncleft controls.

Design

Prospective controlled capture of the facial morphology of infants using a noninvasive three-dimensional stereophotogrammetry method.

Participants

23 children with presurgical cleft: 11 UCL (M = 6, F = 5); 12 UCLP (M = 9, F = 3), and 21 noncleft controls (M = 7, F = 14) were imaged at approximately 3 months of age (range 10 to 16 weeks).

Main Outcome Measure

Accurate, repeatable quantification of facial soft tissues in infants with clefts prior to surgery.

Results

Significant differences (p < .05) were found between the UCLP group and UCL and control groups in anatomical and soft nose width, cleft-side alar wing length, and nasal tip horizontal displacement. Both cleft groups were significantly different from controls and from each other in cleft-side nostril dimensions, alar wing angulation, columella angle, and alar base to corner of mouth dimension; alar base width; and soft tissue defect in nose and the lip and philtrum length bordering the cleft. Significant differences between clefts and controls were identified in the nostril and philtrum on the noncleft side.

Conclusions

The use of children with UCL as controls for UCLP studies is inappropriate. This technique overcame the limitations of direct measurement of infant faces to aid the surgeon in the planning and subsequent re-evaluation of surgical rationale.

Keywords

children cleft lip cleft lip and palate facial morphology infants presurgical soft tissues 3D unilateral

Get full access to this article

View all access options for this article.

References

Al-Omari

Millett

Ayoub

Bock

Ray

Dunaway

Crampin

An appraisal of three methods of rating facial deformity in-patients with repaired complete unilateral cleft lip and palate.

Cleft Palate Craniofac J. 2003; 40: 530–537.

American Academy of Pediatric Dentistry.

Guidelines for the elective use of conscious sedation, deep sedation and general anesthesia in pediatric dental patients: reference manual 1999-2000.

Pediatr Dent. 1999; 21: 68–73.

Ayoub

A.F.

Garrahy

Hood

C.A.

White

Bock

Siebert

Spencer

Ray

Validation of a vision based three-dimensional facial imaging system.

Cleft Palate Craniofac J. 2003; 40: 523–527.

Ayoub

A.F.

Siebert

Moos

K.F.

Wray

Urquhart

Niblett

T.B.

A vision-based three-dimensional capture system for maxillofacial assessment and surgical planning.

Br J Oral Maxillofac Surg. 1998; 36: 353–357.

Ayoub

A.F.

Wray

Moos

K.F.

Jin

Niblett

T.B.

Urquhart

Mowforth

Siebert

A three-dimensional imaging system for archiving dental study casts: a preliminary report.

Int J Adult Orthodon Orthognath Surg. 1997; 12: 79–84.

Bacher

Goz

Pham

Bacher

Werner

Buchner

Bacher

Three-dimensional analysis of cleft palate topology in newborn infants with reference to the cranial skeleton.

Cleft Palate Craniofac J. 1998; 35: 379–395.

Cote

Karl

H.W.

Notterman

D.A.

Weinberg

J.A.

McCloskey

Adverse sedation events in pediatrics: analysis of medications used for sedation.

Pediatrics. 2000; 106: 633–644.

Dahl

Craniofacial morphology in congenital clefts of the lip and palate.

Acta Odontol Scand. 1970; 28(suppl): 57.

Dahl

Kreiborg

Jensen

B.L.

Fogh-Andersen

Comparison of craniofacial morphology in infants with incomplete cleft lip and infants with isolated cleft palate.

Cleft Palate J. 1982; 19: 258–266.

10.

Duffy

Noar

J.H.

Evans

R.D.

Sanders

Three-dimensional analysis of the child cleft face.

Cleft Palate Craniofac J. 2000; 37: 137–144.

11.

Farkas

L.G.

Anthropometry of the face in cleft patients. In: Bardach

Morris

H.L.

, eds. Multidisciplinary Management of Cleft Lip and Palate. Philadelphia: Saunders; 1990: 474–482.

12.

Farkas

L.G.

Anthropometry of the Head and Face. 2nd ed. New York: Raven Press; 1994.

13.

Farkas

L.G.

Clinical evaluation of facial morphology in cleft lip palate patients.

Plast Reconstr Surg. 1997; 99: 262–263.

14.

Farkas

L.G.

Hajnis

Posnick

J.C.

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: 1–12.

15.

Farkas

L.G.

Lindsay

W.K.

Morphology of the adult face following repair of unilateral cleft lip and palate in childhood.

Plast Reconstr Surg. 1973; 52: 652–655.

16.

Fisher

D.M.

L.J.

Chen

Y.R.

Noordhoff

M.S.

Three-dimensional computed tomographic analysis of the primary nasal deformity in 3-month-old infants with complete unilateral cleft lip and palate.

Plast Reconstr Surg. 1999; 103: 1826–1834.

17.

Fisher

D.M.

Mann

R.J.

A model for the cleft lip nasal deformity.

Plast Reconstr Surg. 1998; 101: 1448.

18.

FitzPatrick

D.R.

Raine

P.A.

Boorman

J.G.

Facial clefts in the west of Scotland in the period 1980-1984: epidemiology and genetic diagnoses.

J Med Genet. 1994; 31: 126–129.

19.

Friede

Figueroa

A.A.

Naegele

M.L.

Gould

H.J.

Kay

, Aduss

Craniofacial growth data for cleft lip patients infancy to 6 years of age: potential applications.

Am J Orthod Dentofacial Orthop. 1986; 90: 388–409.

20.

Gregg

Boyd

Richardson

The incidence of cleft lip and palate in Northern Ireland from 1980-1990.

Br J Orthod. 1994; 21: 387–392.

21.

Hairfield

W.M.

Warren

D.W.

Seaton

D.L.

Prevalence of mouth breathing in cleft lip and palate.

Cleft Palate J. 1988; 25: 135–138.

22.

Hajnis

Farkas

L.G.

Ngim

R.C.K.

Racial and ethnic morphometric differences in the craniofacial complex. In: Farkas

L.G.

, ed. Anthropometryof the Head and Face. New York: Raven Press; 1994: 201–218.

23.

Hermann

N.V.

Jensen

B.L.

Dahl

Bolund

Kreiborg

A comparison of the craniofacial morphology in 2-month-old unoperated infants with unilateral complete cleft lip and palate, and unilateral incomplete cleft lip.

J Craniofac Genet Dev Biol. 1999; 19: 80–93.

24.

Hood

C.A.

Bock

Hosey

M.T.

Ayoub

Facial Asymmetry—3D assessment of infants with cleft lip and palate. Presented at the Annual Scientific Meeting of BSPD; Sheffield, United Kingdom; 2002. Int J Paed Dent. 2002;12: 381–382.

25.

Hurwitz

D.J.

Ashby

E.R.

Llull

Pasqual

Tabor

Garrison

Gillen

Weyant

Computer-assisted anthropometry for outcome assessment of cleft lip.

Plast Reconstr Surg. 1999; 103: 1608–1623.

26.

Johnston

Millett

Ayoub

Bock

Are facial expressions reproducible?

Cleft Palate Craniofac J. 2003; 40: 291–296.

27.

Krogman

W.M.

Jain

R.B.

Long

R.E.

Sex differences in craniofacial growth from one month to ten years of cleft lip and palate.

Cleft Palate J. 1982; 19: 62–71.

28.

Mackay

Bottomley

Semb

Roberts

Dentofacial form in the five-year-old child with unilateral cleft lip and palate.

Cleft Palate Craniofac J. 1994; 31: 372–375.

29.

Malek

The lip and nose. In: Cleft Lip and Palate: Lesions, Pathophysiology and Primary Treatment. London: Martin Dunitz, 2001: 29–102.

30.

Mishima

Mori

Yamada

Sugahara

Anthropometric analysis of the nose in the Japanese.

Cells Tissues Organs. 2002; 170: 198–206.

31.

Molsted

Asher-McDade

Brattstrom

Dahl

Mars

McWilliam

Plint

D.A.

Prahl-Andersen

Semb

Shaw

W.C.

A six-center international study of treatment outcome in patients with clefts of the lip and palate: Part 2. Craniofacial form and soft tissue profile.

Cleft Palate Craniofac J. 1992; 29: 398–404.

32.

Mulliken

J.B.

Burvin

Farkas

L.G.

Repair of bilateral complete cleft lip: intraoperative nasolabial anthropometry.

Plast Reconstr Surg. 2001; 107: 307–314.

33.

O'Grady

K.F.

Antonyshyn

O.M.

Facial asymmetry: three-dimensional analysis using laser surface scanning.

Plast Reconstr Surg. 1999; 104: 928–937.

34.

Poswillo

D.E.

General Anaesthesia, Sedation and Resuscitation in Dentistry. Report of an expert working party prepared for the Standing Dental Advisory Committee. London, UK: Central Health Services Council; 1990.

35.

Shaw

W.C.

Asher-McDade

Brattstrom

Dahl

McWilliam

Molsted

Plint

D.A.

Prahl-Andersen

Semb

The

R.P.

A six-center international study of treatment outcome in patients with clefts of the lip and palate: Part 1. Principles and study design.

Cleft Palate Craniofac J. 1992a; 29: 393–397.

36.

Shaw

W.C.

Dahl

Asher-McDade

Brattstrom

Mars

McWilliam

Molsted

Plint

D.A.

Prahl-Andersen

Roberts

A six-center international study of treatment outcome in patients with clefts of the lip and palate: Part 5. General discussion and conclusions.

Cleft Palate Craniofac J. 1992b; 29: 413–418.

37.

Stone

D.H.

Dolk

High reported prevalence of congenital abnormalities in a Scottish city.

Scott Med J. 1994; 39: 170–172.

38.

Vegter

Mulder

J.W.

Hage

J.J.

Major residual deformities in cleft patients: a new anthropometric approach.

Cleft Palate Craniofac J. 1997; 34: 106–110.

39.

Womersley

Stone

D.H.

Epidemiology of facial clefts.

Arch Dis Child. 1987; 62: 717–720.

40.

Yamada

Mori

Minami

Mishima

Tsukamoto

Surgical results of primary lip repair using the triangular flap method for the treatment of complete unilateral cleft lip and palate: a three- dimensional study in infants to four-year-old children.

Cleft Palate Craniofac J. 2002a; 39: 497–502.

41.

Yamada

Mori

Minami

Mishima

Tsukamoto

Three-dimensional analysis of facial morphology in normal Japanese children as control data for cleft surgery.

Cleft Palate Craniofac J. 2002b; 39: 517–526.

42.

Yamada

Sugahara

Mori

Minami

Sakuda

Development of a 3D measurement and evaluation system for facial forms with a liquid crystal range finder.

Comput Methods Programs Biomed. 1999; 58: 159–173.

43.

Zhu

N.W.

Senewiratne

Pigott

R.W.

Lip posture and mouth width in children with unilateral cleft lip.

Br J Plast Surg. 1994; 47: 301–305.