Simultaneous 3-Dimensional Facial and Maxillary Archform Changes After Primary Lip Repair in Complete Unilateral Cleft Lip and Palate.

Abstract

ObjectivesAssessment of simultaneous 3-dimensional facial and maxillary archform changes after primary lip repair in cUCLP.DesignRetrospective longitudinal case series.SettingsKing's College London, United Kingdom.PatientsConsecutive facial plaster cast sets of 18 infants with cUCLP, pre lip (3 months), and pre palate repair (6 months).InterventionsSingle Consultant Cleft Plastic Surgeon in single cleft area operated on all cases and created all casts once anesthetized. One operator scanned all casts, exporting .stl files for analysis.Main outcome measuresTwenty-six facial and maxillary arch landmarks were defined. From these, 11 variables describing linear and volumetric changes were calculated. Landmark identification precision was assessed through a repeatability study. Color maps for visualization of changes after lip repair were created by superimposition. Parametric 1- and 2- sample t tests were used to compare changes between lip and palate repairs. The study had sufficient power (0.80). Clinically significant changes were defined ≥2 mm for nose and ≥4 mm for cleft widths, and ≥5 mm3 for nose and ≥2 mm³ for maxillary archform volumes.ResultsGood precision of landmark identification was confirmed. The main study showed a statistically and clinically significant decrease in overall nasal width (3.24 mm, 95%CI [1.76, 4.71], P = .04) and decrease in average cleft width volume (4.62 mm³, 95% CI [2.58, 6.66], P < .01) after lip repair. Color maps showed concordance with numerical findings.ConclusionsAfter lip repair, there was simultaneous nose width reduction, better nasal symmetry, changes in overall palatal alveolar ridges volume, and decrease in volume of alveolar cleft and anterior ridge of palate.