Midface asymmetry in non-syndromic unilateral cleft lip-palate: A retrospective cbct analysis

Year 2024, Volume: 58 Issue: 2, 83 - 87, 08.05.2024

Berkhas Tumani Üstdal , Burcu Evlice , Hazal Duyan Yüksel

https://doi.org/10.26650/eor.20241169632

Abstract

Purpose: The aim of this study was to determine the relationship between the zygomaticomaxillary complex (ZMC) and infraorbital foramen region (IFR) with facial symmetry in patients with unilateral cleft lip and palate (UCLP) using cone beam computed tomography (CBCT).
Materials and Methods: In this retrospective study, CBCT images of 30 non-syndromic UCLP patients were included, along with 30 age- and sex-matched control individuals. ZMC symmetry was evaluated in the axial section by comparing the right and left sides. Similarly, symmetry in the IFR was assessed in the coronal section. The significance level was set at p<0.05 for statistical analysis.
Results: The study group comprised 12 female and 18 male patients, with ages ranging from 10 to 18 years (mean age 14.1 years). Both ZMC and IFR measurements were significantly lower on the cleft sides of the study group compared to both the noncleft sides of UCLP patients and the control group (p<0.001, p=0.022, and p=0.036, respectively). Furthermore, IFR measurements were significantly lower in the control group compared to the non-cleft sides of the study group (p=0.04).
Conclusion: This study demonstrated that individuals with UCLP exhibit asymmetry in both the ZMC and the IFR. These findings suggest a negative impact on facial aesthetics.

Keywords

Facial asymmetry, cleft lip-palate, midface symmetry, esthetics, cone beam

Non-Sendromik Unilateral Dudak-Damak Yarığında Orta Yüz Asimetrisi: Retrospektif Bir KIBT Analizi

Abstract

Amaç: Bu çalışmanın amacı, unilateral dudak damak yarığı (UDDY) olan hastalarda konik ışınlı bilgisayarlı tomografi (KIBT) kullanarak zigomatikomaksiller kompleks (ZMK) ve infraorbital foramen bölgesinin (IFB) yüz simetrisi ile ilişkisini belirlemektir.
Gereç ve Yöntem: Bu retrospektif çalışmaya yaş ve cinsiyet açısından uyumlu 30 non-sendromik UDDY’li ve 30 sağlıklı bireyin KIBT görüntüleri dahil edildi. ZMK simetrisi aksiyal kesitte sağ-sol taraflardan değerlendirildi. IFB’deki simetriyi belirlemek için ölçümler koronal kesitte sağ-sol taraflardan yapıldı. İstatistiksel analizde anlamlılık düzeyi p<0,05 olarak belirlendi.
Bulgular: Çalışma grupları 12 kadın ve 18 erkek hastadan (yaş aralığı:10-18, ortalama yaş:14.1) oluşmaktadır. ZMK ve IFB ölçümleri çalışma grubunun yarık olan tarafında, hem UDDY’nin yarık olmayan tarafına kıyasla hem de kontrol grubuna kıyasla anlamlı derecede düşüktü [sırasıyla (p<0.001), (p=0.022) ve (p=0.036)]. Ayrıca kontrol grubunun IFB ölçümleri çalışma grubunun yarık olmayan tarafına kıyasla anlamlı derecede düşüktü (p=0,04).
Sonuç: Bu çalışma, UDDY’li bireylerin hem ZMK’te hem de IFB’de asimetriye sahip olduğunu göstermektedir. Bu durum yüz estetiği açısından olumsuz bir etki yaratır.

Keywords

Yüz asimetrisi, Dudak damak yarığı, Orta yüz simetrisi, estetik, konik ışın

References

• 1. Cheong YW, Lo LJ. Facial asymmetry: etiology, evaluation, and management. Chang Gung Med J 2011;34:341-51. google scholar
• 2. Molsted K, Dahl E. Asymmetry of the maxilla in children with complete unilateral cleft lip and palate. Cleft Palate J 1990;27:184-92. [CrossRef] google scholar
• 3. Shackelford TK, Larsen RJ. Facial asymmetry as an indicator of psychological, emotional, and physiological distress. J Pers Soc Psychol 1997;72:456-66. [CrossRef] google scholar
• 4. Grammer K, Thornhill R. Human (Homo sapiens) facial attractiveness and sexual selection: The role of symmetry and averageness. J Comp Psychol 1994;108:233-42. [CrossRef] google scholar
• 5. Gong X, He Y, He Y, An J, Yang Y, Zhang Y. Quantitation of Zygomatic Complex Symmetry Using 3-Dimensional Computed Tomography. J Oral Maxillofac Surg 2014; 72:2053. e1-8. [CrossRef] google scholar
• 6. Khaqani MS, Tavosi F, Gholami M, Eftekharian HR, Khojastepour L. Analysis of Facial Symmetry After Zygomatic Bone Fracture Management. J Oral Maxillofac Surg 2018;76:595-604. [CrossRef] google scholar
• 7. Ras F, Habets LLMH, 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. [CrossRef] google scholar
• 8. Molsted K, Kjaer I, Dahl E. Cranial base in newborns with complete cleft lip and palate: radiographic study. The Cleft Palate Craniofac J 1995;32:199-205. [CrossRef] google scholar
• 9. Hoh E, Sulaiman W. Analysis of preoperative measurements in unilateral cleft lip patients toward the outcome of secondary cleft deformities. J Cleft Lip Palate Craniofac Anomal 2019;6:93-8. [CrossRef] google scholar
• 10. Edler R, Rahim MA, Wertheim D, Greenhill D. The Use of Facial Anthropometrics in Aesthetic Assessment. Cleft Palate Craniofac J 2010;47:48-57. [CrossRef] google scholar
• 11. Trotman CA, Faraway JJ, Essick GK. Three-dimensional nasolabial displacement during movement in repaired cleft lip and palate patients. Plast Reconstr Surg 2000;105:1273-83. [CrossRef] google scholar
• 12. Meyer-Marcotty P, Alpers GW, Gerdes ABM, Stellzig-Eisenhauer A. Impact of facial asymmetry in visual perception: a 3-dimensional data analysis. Am J Orthod Dentofac Orthop 2010;137:168.e1-8. [CrossRef] google scholar
• 13. Yânez-Vico RM, Iglesias-Linares A, Torres-Lagares D, Gutierrez-Perez JL, Solano-Reina E. Three-dimensional evaluation of craniofacial asymmetry: an analysis using computed tomography. Clin Oral Invest 2010;15:729-36. [CrossRef] google scholar
• 14. Choi YK, Park SB, Kim YI, Son WS. Three-dimensional evaluation of midfacial asymmetry in patients with nonsyndromic unilateral cleft lip and palate by cone-beam computed tomography. Korean J Orthod 2013;43:113-9. [CrossRef] google scholar
• 15. Furst I. M, Austin P, Pharoah M, Mahoney J. The use of computed tomography to define zygomatic complex position. J Oral Maxillofac Surg 2001;59:647-54. [CrossRef] google scholar
• 16. Rossi M, Ribeiro E, Smith R. Craniofacial Asymmetry in Development: An Anatomical Study. Angle Orthod 2003;73:381-5. google scholar
• 17. Damstra J, Fourie Z, De Wit M. A three-dimensional comparison ofa morphometric and conventional cephalometric midsagittal planes for craniofacial asymmetry. Clin Oral Invest 2012;16:285-94. [CrossRef] google scholar
• 18. Roumeliotis G, Willing R, Neuert M, Ahluwalia R., Jenkyn T., & Yazdani, A. Application of a Novel Semi-Automatic Technique for Determining the Bilateral Symmetry Plane of the Facial Skeleton of Normal Adult Males. J Craniofac Surg 2015;26:1997-2001. [CrossRef] google scholar
• 19. Harikrishnan P, Balakumaran V. Analysis of Intramaxillary and Mid-Face Skeletal Asymmetry in a Three-Dimensional Model With Complete Unilateral Cleft Lip and Palate. J Craniofac Surg 2018;29:759-62. [CrossRef] google scholar
• 20. Macleod I, Heath N. Cone-Beam Computed Tomography (CBCT) in Dental Practice. Dental Update 2008;35:590-8. [CrossRef] google scholar
• 21. Sherrard JF, Rossouw PE, Benson BW, Carrillo R, & Buschang PH. Accuracy and reliability of tooth and root lengths measured on cone-beam computed tomographs. Am J Orthod Dentofac Orthop 2010;137:100-8. [CrossRef] google scholar
• 22. Agarwal, R., Parihar, A., Mandhani, P. A., & Chandra, R. Three-Dimensional Computed Tomographic Analysis of the Maxilla in Unilateral Cleft Lip and Palate. J Craniofac Surg 2012;23:1338-42. [CrossRef] google scholar
• 23. Patel, D. S., Jacobson, R., Duan, Y., Zhao, L., Morris, D., & Cohen, M. N. Cleft Skeletal Asymmetry: Asymmetry Index, Classification and Application. Cleft Palate-Craniofac J 2017;55:348-55. [CrossRef] google scholar
• 24. Bugaighis, I., Mattick, C. R., Tiddeman, B., & Hobson, R. 3D asymmetry of operated children with oral clefts. Orthod & Craniofac Res 2013;17:27-37. [CrossRef] google scholar
• 25. Yang, Li’an; Chen, Zhenqi; Zhang, Xiaoyue. A cone-beam computed tomography evaluation of facial asymmetry in unilateral cleft lip and palate individuals. J Oral Sci 2016;58:109-15. [CrossRef] google scholar