Abstract
Objective:Assess facial asymmetry during maximum smile in patients with surgically managed unilateral cleft lip and palate (UCLP), using a dynamic 3-dimensional (3D) imaging (4-dimensional) system.Design:Prospective 2 cohort comparative study.Methods:Twenty-five surgically managed UCLP cases and 75 controls at 8 to 10 years of age were recruited. Facial movements during maximum smile were recorded using video stereophotogrammetry at a rate of 60 3D facial images per second. Maximum smile took approximately 3 seconds and generated 180 3D facial images for the analysis. A generic facial mesh which consists of more than 7000 quasi landmarks was used for the assessment of facial asymmetry at 5 key 3D frames representing the pattern of maximum smile.Results:Statistically significant differences were seen regarding the magnitude of facial asymmetry between the UCLP group and the noncleft controls. Higher average asymmetry in the UCLP group was seen in the 3D frame midway between maximum smile and rest (frame 4) followed by the frame at peak expression of maximum smile (frame 3). The average magnitude of nasolabial asymmetry of the control group was within 0.5 mm in comparison with the UCLP cases which was about 1.8 mm.Conclusion:This study provided for the first time, an objective tool for analysis of the dynamics of muscle movements which provided an unprecedented insight into the anatomical basis of the residual dysmorphology. The research demonstrates the limitations of the primary lip repair in achieving symmetrical results and underpins the required refinements to improve the quality of surgical repair of cleft lip.
Highlights
Cleft Lip and palate (CLP) is a craniofacial anomaly that affects 1 in 700 children per year (Thomason & Dixon, 2009)
This study provided for the first time, an objective tool for analysis of the dynamics of muscle movements which provided an unprecedented insight into the anatomical basis of the residual dysmorphology
Frame 3 illustrates the average magnitude and the distribution pattern of nasolabial asymmetry of the control group which was within 0.5 mm in comparison with the unilateral cleft lip and palate (UCLP) cases which was about 1.8 mm
Summary
Cleft Lip and palate (CLP) is a craniofacial anomaly that affects 1 in 700 children per year (Thomason & Dixon, 2009). The focus of the surgical repair of cleft lip is to improve lip functions and facial aesthetics. Facial asymmetry is not fully eliminated (Seaward et al, 2015). The residual asymmetry results from the formed scar tissue, muscular pull, and relatively thinner tissues at the surgical site (Otero et al, 2012). In addition to the static facial asymmetry (in a still facial image), the distorted facial movements after the surgical repair of cleft lip have a profound psychosocial impact (Shaw, 1981). In this era of a high-pressured celebrity culture, Kingdom 5 Scottish Craniofacial Research Group, Glasgow University Dental Hospital &
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