Four-Dimensional Changes of Nasolabial Positions in Unilateral Cleft Lip and Palate

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The aim of this study was to analyze the accurate three-dimensional positions and positional changes of the lip and nose in patients with unilateral cleft lip and palate. Sixty-three patients with unilateral complete cleft lip and palate (UCLP) and 96 patients with isolated cleft palate were retrospectively enrolled. Facial casts of all subjects taken immediately before and after cheiloplasty and before palatoplasty were used. Three-dimensional values of 12 landmarks were measured by electronic caliper and parallel milling machine. Independent-samples t test was used in analyzing positional differences between UCLP and control, and 2-way analysis of variance was selected in analyzing positional changes among UCLP groups. The threshold of significance was set at 0.05. Superiorly dislocated christa philtri (Cph) (P < 0.001), subalae (Sa) (P < 0.001), and nostril tip (Nt) (P < 0.001) were partially corrected and still dislocated (P < 0.05, P < 0.001, P < 0.001) immediately after operation, but Cph (P = 0.322) and Cph' (P = 0.081) developed caudally to normal about 10 months after primary surgery. In sagittal dimension, lip and nose, especially Cph' (P < 0.001), Sa' (P < 0.001), and Nt' (P < 0.001) on the cleft side, dislocated dorsally before operation. Immediately after operation, Sa' (P = 0.456) and Nt' (P = 0.067) were normal in sagittal projection, but Cph' was corrected partially and still insufficient (P < 0.001). Unfortunately, sagittal projections of all nasolabial structures, Cph (P < 0.001), Sa' (P < 0.001), Nt (P < 0.001), Cph' (P < 0.001), Sa' (P < 0.05), and Nt' (P < 0.001), decreased significantly and were insufficient after operation. In vertical dimension, nasolabial displacements were corrected partially by primary surgery, and catching-up growth happened since then. Insufficient sagittal projections of the lip and nose were corrected successfully by lip repair, but lip repair itself had adverse effects on nasolabial sagittal growth.