Browse > Article
http://dx.doi.org/10.4041/kjod.2013.43.3.113

Three-dimensional evaluation of midfacial asymmetry in patients with nonsyndromic unilateral cleft lip and palate by cone-beam computed tomography  

Choi, Youn-Kyung (Department of Orthodontics, Pusan National University Dental Hospital)
Park, Soo-Byung (Department of Orthodontics, Pusan National University Dental Hospital)
Kim, Yong-Il (Department of Orthodontics, School of Dentistry, Pusan National University)
Son, Woo-Sung (Department of Orthodontics, Pusan National University Dental Hospital)
Publication Information
The korean journal of orthodontics / v.43, no.3, 2013 , pp. 113-119 More about this Journal
Abstract
Objective: To compare three-dimensionally the midfacial hard- and soft-tissue asymmetries between the affected and the unaffected sides and determine the relationship between the hard tissue and the overlying soft tissue in patients with nonsyndromic complete unilateral cleft lip and palate (UCLP) by cone-beam computed tomography (CBCT) analysis. Methods: The maxillofacial regions of 26 adults (18 men, 8 women) with nonsyndromic UCLP were scanned by CBCT and reconstructed by three-dimensional dental imaging. The frontal-view midfacial analysis was based on a $3{\times}3$ grid of vertical and horizontal lines and their intersecting points. Two additional points were used for assessing the dentoalveolar area. Linear and surface measurements from three reference planes (Basion-perpendicular, midsagittal reference, and Frankfurt horizontal planes) to the intersecting points were used to evaluate the anteroposterior, transverse, and vertical asymmetries as well as convexity or concavity. Results: Anteroposteriorly, the soft tissue in the nasolabial and dentoalveolar regions was significantly thicker and positioned more anteriorly on the affected side than on the unaffected side (p < 0.05). The hard tissue in the dentoalveolar region was significantly retruded on the affected side compared with the unaffected side (p < 0.05). The other midfacial regions showed no significant differences. Conclusions: With the exception of the nasolabial and dentoalveolar regions, no distinctive midfacial hard- and soft-tissue asymmetries exist between the affected and the unaffected sides in patients with nonsyndromic UCLP.
Keywords
Computed tomography; Cleft lip and palate; Asymmetry; Soft tissue;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Mossey PA, Little J, Munger RG, Dixon MJ, Shaw WC. Cleft lip and palate. Lancet 2009;374:1773-85.   DOI
2 Baik HS, Keem JH, Kim DJ. The prevalence of cleft lip and/or cleft palate in Korean male adult. Korean J Orthod 2001;31:63-9.
3 Li J, Shi B, Liu K, Zheng Q. A preliminary study on the hard-soft tissue relationships among unoperated secondary unilateral cleft nose deformities. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;113:300-7.   DOI
4 Atherton JD. Morphology of facial bones in skulls with unoperated unilateral cleft palate. Cleft Palate J 1967;4:18-30.
5 Joos U. Skeletal growth after muscular reconstruction for cleft lip, alveolus and palate. Br J Oral Maxillofac Surg 1995;33:139-44.   DOI
6 Stauber I, Vairaktaris E, Holst A, Schuster M, Hirschfelder U, Neukam FW, et al. Three-dimensional analysis of facial symmetry in cleft lip and palate patients using optical surface data. J Orofac Orthop 2008;69:268-82.   DOI
7 Meyer-Marcotty P, Alpers GW, Gerdes AB, Stellzig- Eisenhauer A. Impact of facial asymmetry in visual perception: a 3-dimensional data analysis. Am J Orthod Dentofacial Orthop 2010;137:168.e1-8.
8 Son WS, Kim MK. Facial asymmetry of unilateral cleft lip and palate patients. Korean J Orthod 1995; 25:13-8.
9 Molsted K, Dahl E. Asymmetry of the maxilla in children with complete unilateral cleft lip and palate. Cleft Palate J 1990;27:184-90.   DOI
10 Molsted K, Kjaer I, Dahl E. Cranial base in newborns with complete cleft lip and palate: radiographic study. Cleft Palate Craniofac J 1995;32:199-205.   DOI
11 Ras F, Habets LL, van Ginkel FC, Prahl-Andersen B. Three-dimensional evaluation of facial asymmetry in cleft lip and palate. Cleft Palate Craniofac J 1994; 31:116-21.   DOI
12 Broder HL, Smith FB, Strauss RP. Effects of visible and invisible orofacial defects on self-perception and adjustment across developmental eras and gender. Cleft Palate Craniofac J 1994;31:429-36.   DOI
13 Lee LW, Chen SH, Yu CC, Lo LJ, Lee SR, Chen YR. Stigma, body image, and quality of life in women seeking orthognathic surgery. Plast Reconstr Surg 2007;120:225-31.   DOI
14 Laspos CP, Kyrkanides S, Tallents RH, Moss ME, Subtelny JD. Mandibular asymmetry in noncleft and unilateral cleft lip and palate individuals. Cleft Palate Craniofac J 1997;34:410-6.   DOI
15 Smahel Z, Brejcha M. Differences in craniofacial morphology between complete and incomplete unilateral cleft lip and palate in adults. Cleft Palate J 1983;20:113-27.
16 Kurt G, Bayram M, Uysal T, Ozer M. Mandibular asymmetry in cleft lip and palate patients. Eur J Orthod 2010;32:19-23.   DOI
17 Hwang HS, Hwang CH, Lee KH, Kang BC. Maxillofacial 3-dimensional image analysis for the diagnosis of facial asymmetry. Am J Orthod Dentofacial Orthop 2006;130:779-85.   DOI
18 Suri S, Utreja A, Khandelwal N, Mago SK. Craniofacial computerized tomography analysis of the midface of patients with repaired complete unilateral cleft lip and palate. Am J Orthod Dentofacial Orthop 2008;134:418-29.   DOI
19 Kim YI, Kim JR, Park SB. Three-dimensional analysis of midfacial soft tissue changes according to maxillary superior movement after horizontal osteotomy of the maxilla. J Craniofac Surg 2010;21: 1587-90.   DOI
20 de Moraes ME, Hollender LG, Chen CS, Moraes LC, Balducci I. Evaluating craniofacial asymmetry with digital cephalometric images and cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2011;139:e523-31.   DOI
21 Kyrkanides S, Klambani M, Subtelny JD. Cranial base and facial skeleton asymmetries in individuals with unilateral cleft lip and palate. Cleft Palate Craniofac J 2000;37:556-61.   DOI
22 Zemann W, Santler G, Kärcher H. Analysis of midface asymmetry in patients with cleft lip, alveolus and palate at the age of 3 months using 3DCOSMOS measuring system. J Craniomaxillofac Surg 2002;30:148-52.   DOI
23 Kim YH, Sato K, Mitani H, Shimizu Y, Kikuchi M. Asymmetry of the sphenoid bone and its suitability as a reference for analyzing craniofacial asymmetry. Am J Orthod Dentofacial Orthop 2003;124:656-62.   DOI
24 Suzuki H, Yamaguchi T, Furukawa M. Rhinologic computed tomographic evaluation in patients with cleft lip and palate. Arch Otolaryngol Head Neck Surg 1999;125:1000-4.   DOI
25 Kolbenstvedt A, Aaløkken TM, Arctander K, Johannessen S. CT appearances of unilateral cleft palate 20 years after bone graft surgery. Acta Radiol 2002; 43:567-70.   DOI
26 Sade Hoefert C, Bacher M, Herberts T, Krimmel M, Reinert S, Goz G. 3D soft tissue changes in facial morphology in patients with cleft lip and palate and class III mal occlusion under therapy with rapid maxillary expansion and delaire facemask. J Orofac Orthop 2010;71:136-51.   DOI
27 Breitsprecher L, Fanghänel J, Metelmann HR, Mlynski G, Würfel F, Freise K, et al. The influence of the muscles of facial expression on the development of the midface and the nose in cleft lip and palate patients. A reflection of functional anatomy, facial esthetics and physiology of the nose. Ann Anat 1999;181:19-25.   DOI
28 Markus AF, Precious DS. Effect of primary surgery for cleft lip and palate on mid-facial growth. Br J Oral Maxillofac Surg 1997;35:6-10.   DOI
29 Markus AF, Delaire J, Smith WP. Facial balance in cleft lip and palate. II. Cleft lip and palate and secondary deformities. Br J Oral Maxillofac Surg 1992;30:296-304.   DOI
30 Carstens MH. Functional matrix cleft repair: principles and techniques. Clin Plast Surg 2004;31:159-89.   DOI