Three-dimensional assessment of facial appearance following surgical repair of unilateral cleft lip and palate

Abstract

Background: The desired surgical outcome of treatment for cleft lip and palate is a symmetrical facial appearance with minimal residual scarring. Objective assessment of post-surgical facial asymmetry can be difficult but three-dimensional (3D) imaging techniques have made this easier to achieve. This study assessed residual asymmetry in surgically repaired unilateral cleft lip (UCL) and unilateral cleft lip and palate (UCLP) patients, and compared this with non-cleft controls. Methods: Fifty-one ten year old children with surgically managed UCLP and 44 UCL were compared with a control group of 68 ten year olds. 3D facial models at rest and with maximum smile were created using a 3D imaging system. Asymmetry scores were produced using both anatomical landmarks and a novel method of facial curve analysis. Results: Asymmetry for the whole face was significantly higher in both cleft groups compared with controls (p<0.001). UCLP asymmetry was higher than UCL (p<0.001). In cleft patients the upper lip and nasal rim were the most asymmetric (p<0.001-0.05). Control subjects also displayed a degree of facial asymmetry. Maximum smile did not significantly affect the symmetry of the whole face but it increased asymmetry of the vermillion border and nasal rim in all three groups (p<0.001). Conclusions: Despite surgical intervention at an early age, asymmetry remains significant in cleft patients at age ten years. 3D Imaging is a non-invasive objective assessment tool that identifies specific areas of the face responsible for asymmetry. Facial curve analysis describes the face more comprehensively and characterises, soft tissue contours.