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Degree of Asymmetry Between Patients With Complete and Incomplete Cleft Lips.

Authors
  • Jodeh, Diana S1
  • Soni, Sara2
  • Cray, James J3
  • Rottgers, S Alex1
  • 1 Division of Plastic and Reconstructive Surgery, 7582Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.
  • 2 Department of Plastic Surgery, 7831University of South Florida, Morsani College of Medicine, Tampa, FL, USA.
  • 3 Department of Biomedical Education & Anatomy, 12305The Ohio State University College of Medicine, Columbus, OH, USA.
Type
Published Article
Journal
The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association
Publication Date
May 01, 2021
Volume
58
Issue
5
Pages
539–545
Identifiers
DOI: 10.1177/1055665620962365
PMID: 32996328
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Surgical outcomes for patients with complete cleft lips are not as ideal as those achieved for milder phenotypes. We hypothesized that in addition to the greater width of the cleft, patients with complete cleft lip and palate exhibit a greater degree of hypoplasia and asymmetry. Stereophotographs of 14 infants with unrepaired unilateral complete and 14 with incomplete cleft lips were measured using Vectra imaging software (Canfield Imaging). Unpaired t tests were used to compare measured asymmetry between groups. Measurements included nasion to endocathion, sn-sbal, subnasale to alare (sn-al), subnasale to crista philtra, subalare to crista philtra (sbal-cphi), chelion to crista philtra, lateral lip element fullness, medial lip element fullness (mef), and non-cleft lip fullness. Duplicate measurements allowed Pearson correlation to be used to determine intra-rater reliability. Statistical significance was set at P < .05. Degree of asymmetry of the nasal base, sn-al, and sn-sbal was significantly greater for patients with complete clefts (P = .0001, P = .0001). Hypoplasia of the lateral lip element was seen when comparing lateral and mef (P = .04, P = .004) and lateral lip height (sbal-cphi''; P = .002). The degree of cupid's bow asymmetry did not differ between groups (P = .23). Intrarater reliability was high for all facial measures, ranging from 0.70 to 0.99. More severe, complete cleft lips demonstrate statistically significant greater asymmetry in surgically relevant dimensions. There was greater width of the nasal base. Vertical asymmetry of cupid's bow was unaffected by cleft severity, but that asymmetry was greater in patients with complete clefts due to hypoplasia of the lateral lip element. This may contribute to the less favorable results in these patients.

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