Effect on Facial Growth of the Management of Cleft Lip and Palate

Comparative Evaluation of Relapse After LeFort 1 Osteotomy in Cleft Palate and Non-cleft Individuals: A Longitudinal Study

PURPOSE

The aim of this study was to assess and compare the likelihood of relapse one year after LeFort I advancement surgery in patients with and without cleft lip and palate.

METHODS

A retrospective observational study which included two groups of participants who underwent LeFort I maxillary advancement was performed. Group 1 included 10 non-cleft subjects and Group 2 included 21 subjects with cleft palate. These maxillary deficient patients were chosen and operated using a technique where only a sagittal displacement was intended. Patients who underwent additional mandibular surgery, significant vertical or transverse alterations, or both were excluded. Pre-operative (T1), immediately post-operative (T2), and minimum one-year follow-up (T3) lateral cephalograms were studied for each group. Skeletal stability and dental stability after LeFort I surgery at a minimum of one-year follow-up in cleft palate and non-cleft patients were evaluated.

RESULTS

For the given sample size, relapse tendencies showed statistically significant differences between cleft palate patients and non-cleft palate patients after maxillary advancement. The sella nasion angle and horizontal overlap of the maxillary and mandibular incisors (overjet) decreased by 2 degrees and 0.9 mm respectively in the cleft palate group while decreasing by 1.10 degrees and 0.40 mm in the non-cleft group.

CONCLUSIONS

After maxillary advancement with LeFort I osteotomy and miniplate fixation in patients with cleft palate and non-cleft patients, some degree of relapse was detected in both groups for the given sample size after one year post-operatively. The cleft palate group displayed additional relapse tendencies when compared to the non-cleft group.

Face Structure, Beauty, and Race: A Study of Population Databases Using Computer Modeling

Background

Understanding the differences in facial shapes in individuals from different races is relevant across several fields, from cosmetic and reconstructive medicine to anthropometric studies.

Objectives

To determine whether there are features shared by the faces of an aesthetic female face database and if they correlate to their racial demographics using novel computer modeling.

Methods

The database was formed using the "top 100 most beautiful women" lists released by "For Him Magazine" for the last 15 years. Principal component analysis (PCA) of 158 parameters was carried out to check for clustering or racial correlation with these clusters. PCA is a machine-learning tool used to reduce the number of variables in a large data set, allowing for easier analysis of the data while retaining as much information as possible from the original data set. A review of the literature on craniofacial anthropometric differences across ethnicities was also undertaken to complement the computer data.

Results

Two thousand eight hundred and seventy aesthetic faces formed the database in the same racial proportion as 10,000 faces from the general population as a baseline. PCA clustering illustrated grouping by latent space parameters for facial dimensions but showed no correlation with racial demographics. There was a commonality of facial features within the aesthetic cohort, which differed from the general population. Fourteen papers were included in the review which contained 8142 individuals.

Conclusions

Aesthetic female faces have commonalities in facial features regardless of racial demographic, and the dimensions of these features vary from the baseline population. There may even be a common human aesthetic proportion that transcends racial boundaries, but this is yet to be elucidated.

Level of Evidence 5

A nationwide cohort study on growth impairment by cleft lip with or without palate

There are very few nationwide studies discussing the height, weight, head circumference, and dental screening of children with cleft lip with or without palate (CL/P), with most reports on this subject based on a 1900s cohort. This study aimed to characterize CL/P children in the 2000s in terms of height, weight, head circumference, and dental screening. This nationwide population-based study evaluated the National Health Insurance Service-Infants and Children’s Health Screening (NHIS-INCHS), specifically the height, weight, and head circumference of millions of children. Dental screening data, including the status of each tooth and comprehensive dental judgment, were also evaluated. Syndromic and nonsyndromic CL/P children had lower height, weight, and head circumference than no CL/P children until the age of 66–71 months. Children with cleft palate only or both cleft lip and palate showed similar results. Regarding dental screening, the primary teeth of CL/P children erupted later and fell out faster than no CL/P children. Dental caries was also more common in CL/P children. Children with CL/P had inferior general growth, regardless of palatoplasty surgery. More aggressive dental treatment was required for CL/P children due to the instability of primary teeth and tendency for caries.

Skeletal and Dental Correction and Stability Following LeFort I Advancement in Patients With Cleft Lip and Palate With Mild, Moderate, and Severe Maxillary Hypoplasia

OBJECTIVE

This study evaluates skeletal and dental outcomes of LeFort I advancement surgery in patients with cleft lip and palate (CLP) with varying degrees of maxillary skeletal hypoplasia.

DESIGN

Retrospective study.

METHOD

Lateral cephalograms were digitized at preoperative (T1), immediately postoperative (T2), and 1-year follow-up (T3) and compared to untreated unaffected controls. Based on the severity of cleft maxillary hypoplasia, the sample was divided into 3 groups using Wits analysis: mild: ≤0 to ≥-5 mm; moderate: <-5 to >-10 mm; and severe: ≤-10 mm.

PARTICIPANTS

Fifty-one patients with nonsyndromic CLP with hypoplastic maxilla who met inclusion criteria.

INTERVENTION

LeFort I advancement.

MAIN OUTCOME MEASURE

Skeletal and dental stability post-LeFort I surgery at a 1-year follow-up.

RESULTS

At T2, LeFort I surgery produced an average correction of maxillary hypoplasia by 6.4 ± 0.6, 8.1 ± 0.4, and 10.7 ± 0.8 mm in the mild, moderate, and severe groups, respectively. There was a mean relapse of 1 to 1.5 mm observed in all groups. At T3, no statistically significant differences were observed between the surgical groups and controls at angle Sella, Nasion, A point (SNA), A point, Nasion, B point (ANB), and overjet outcome measures.

CONCLUSIONS

LeFort I advancement produces a stable correction in mild, moderate, and severe skeletal maxillary hypoplasia. Overcorrection is recommended in all patients with CLP to compensate for the expected postsurgical skeletal relapse.