Cleft lip and palate is one of the most common deformities of the craniofacial region, and treatment of this deformity is essential for social reintegration. One of the major goals of surgery and treatment of craniofacial deformities is to improve the aesthetic appearance of the face, and thereby improve the patient's social acceptability. Here, we present a critical review of the criteria for aesthetic evaluation of the nasolabial region in cleft patients by assessing publications with the highest level of evidence, including professional evaluation, and patient satisfaction. The findings indicate treatment of this condition represents a major challenge for multidisciplinary team care.

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Evaluating aesthetics of the nasolabial region in children with cleft lip and palate: professional analysis and patient satisfaction

A substantial body of literature has reported on correlates of facial symmetry and facial masculinity/femininity including the role these two traits play in human mate choice. However, major gaps persist, with nearly all data originating from Western industrialised populations, and results remaining largely equivocal when compared across studies. This thesis has two parts: the 1st part sets out to explore if human variation in measures of socioeconomic and health status is reflected in variation in facial asymmetry as a measure of developmental stability, or reflected in variation in facial masculinity/femininity as a measure of facial sexual dimorphism. The faces of 426 participants (215 males, 211 females) from the Hausa ethnic group of northern Nigeria were scanned using a 3D surface laser scanner. This population could potentially provide greater variation in developmental and other environmental factors than studies based on Western industrialised populations. Facial asymmetry and masculinity data were generated from the resulting virtual 3D models, individual biometric data were recorded, and socioeconomic and past medical history data were acquired through questionnaires. For the 2nd part of the thesis, 179 raters (98 males, 81 females) were recruited in order to determine their perceptions and judgements of standardised facial images with different levels of asymmetry and masculinity/femininity using questionnaires. Data were analysed using bivariate and multivariate methods. Significant correlates of whole face asymmetry included age, body height, whole face surface area (WFSA), education and diastolic blood pressure (BP). Significant correlates of asymmetry in the eye region alone included weight, sex, body mass index (BMI), and diastolic BP. Significant correlates of facial masculinity/femininity included body height, number of siblings, income, and total disease loads (TOTDX) in females, and WFSA, occupation and TOTDX in males. In the 2nd part of the study, individuals with higher facial symmetry and facial femininity were perceived as more attractive, more suitable as marriage partners and more caring, whereas less symmetrical and more masculine individuals were perceived as more aggressive. Although the amount of variation explained by statistically significant correlates was routinely low, the results of this study are consistent with an evolutionary psychological perspec¬tive on the link between physical attractiveness, health and environment. The study can also conclusively assert that facial symmetry or masculinity preferences were not just dependent on single, but rather on multiple facial features; thus the study supports that physical attractiveness is not just an arbitrary social construct, but at least in part a cue to general health and related to environmental context.

Correlates of Non-Clinical Facial Asymmetry and Facial Sexual Dimorphism in a Sub-Saharan African Population

Aim The purpose of this study was to evaluate the role of periosteum on the healing and growth of mandible after mandibular outer cortex osteotomy using three-dimensional computed tomography. Methods Eighteen 3-month-old miniature pigs were randomized into three groups. The mandibular outer cortex osteotomy was performed on both sides in group I, and on the left side in group II. In groups I and II, the local periosteum on the left side was resected. In group III, no operation was performed. The evaluation of mandibular morphology of all the animals was performed based on multiple spiral CT data before and after surgery. Results The bone defects healed well when the periosteum was preserved, whereas they healed poorly with residual bone defects when the periosteum was resected after surgery. When the periosteum was resected, the decrease in the mean thickness of the mandibular body was more than that of the contralateral side after surgery. In group I, about 66.7% of the animals exhibited mandible deviation at 24 weeks after surgery. The median point of mentum was inclined toward the side that the periosteum was preserved. In groups II and III, no mandible deviation was observed. Conclusion The periosteum plays an important role in bone growth and fracture healing. Mandibular outer cortex osteotomy inhibited the mandibular development and resulted in postoperative mandibular deviation in young miniature pigs. The simultaneous periosteum resection may offset the phenomenon of mandibular deviation to a certain extent.

3D-CT evaluation of mandibular morphology after mandibular outer cortex osteotomy in young miniature pigs: The role of the periosteum

Objective: To clarify the relationship between mandibular ramus height and function of masticatory muscles in patients with hemifacial microsomia. Design:  Retrospective study of imaging and physiological data. Setting:  Images and physiological data were obtained from the records of Sapporo Medical University Hospital. Patients:  A total of 29 patients with hemifacial microsomia who showed Pruzansky grades I, II deformity. Main Outcome Measures:  Mandibular ramus height and masticatory muscle volume were evaluated with multi-detector row computed tomography. The electromyographic value was measured by the K7 Evaluation System. The hemifacial microsomia patients were classified into three groups based on the mandibular ramus height ratio of the affected and unaffected sides: group 0, >1.00; group 1, 1.00 to 0.85; group 2, <0.85. The Tukey-Kramer method and Games-Howell method were used to determine correlations between parameters. Results:  Decreased mandibular ramus height was significantly correlated w...

Relationship between Mandibular Ramus Height and Masticatory Muscle Function in Patients with Unilateral Hemifacial Microsomia

Introduction Craniofacial anthropometric studies measure the differences in humans' craniofacial dimensions. The aim of this study was to determine facial anthropometric dimensions of newborn to 12-year-old girls with nonsyndromic unilateral cleft lip and palate (UCLP). Methods In this cross-sectional analytical study, data was collected from 65 infant to 12-year old girls with UCLP. Digital frontal and profile facial photographs were transferred to a computer and desired anthropometric landmarks were traced on each image. Fifteen anthropometric parameters were measured which were the angles of facial, nasofacial, nasomental, Z, nasolabial, inclination of nasal base and labial fissure, nasal deviation, mentocervical, facial convexity and also ratios of nasal prominence relative to nasal height, middle to lower facial third, upper lip to lower lip height, columellar length relative to upper lip, and incisal show relative to incisal width. Pearson coefficient and linear regression were used for statistical analysis. Results Upper lip to lower lip height ratio and angles of nasofacial, nasolabial, and facial convexity decreased with the age of the patients. In contrast, nasomental angle and the ratios of columellar length to upper lip length, middle facial height to lower facial height, and incisal show relative to incisal width increased. Other parameters studied did not appear to have any significant correlation with age. Conclusion In the girls with UCLP, various craniofacial dimensions have different growth rates with some parts growing slower than others. Some of the parameters studied were significantly correlated with age, thus growth-related curves and equations were obtained and presented.

Facial Anthropometric Evaluation of Unilateral Cleft Lip and Palate Patients: Infancy Through Adolescence.

Background: The application of three-dimensional computed tomography
(3D CT) to analyse craniofacial morphology in individuals with cleft
lip and palate (CLP) enables detailed assessments to be made of
asymmetry in the region of the cleft and in regions distant from the
cleft. The aim of this study was to compare craniofacial morphology in
a sample of Malaysian infants with unoperated CLP with a control sample
of unaffected Malaysian infants. Methods: The study sample comprised 29
individuals: 10 with unilateral CLP (UCLP), 5 with bilateral CLP
(BCLP), 7 with cleft lip and primary palate (CLPP), and 7 with isolated
cleft palate (ICP). The control sample consisted of 12 non-cleft (NC)
infants. All subjects were between 0.4 and 12.2 months of age. Nine
mid-facial and 4 nasal bone landmarks were located on 3D CT scans and
compared to a midline reference plane, which was created using the
landmarks basion, sella, and nasion. Unpaired t tests and F tests were
used to compare means and variances between sample groups, whereas
paired t tests were used for comparisons within the UCLP and NC groups.
Results: Differences in variances of some mid-facial breadths and nasal
bone dimensions were found in both male and female cleft groups when
compared to the NC sample. In the UCLP group, some nasal bone and
facial breadth dimensions were larger than in the NC sample and the
nasal bone tended to deviate to the contralateral side of the cleft.
Conclusion: CLP affects the size and orientation of the nasal bones and
is associated with an altered morphology of some facial bones at
positions distant from the region of the cleft.

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Nikki Tziavaras

Papers

A three-dimensional computed tomography analysis of craniofacial asymmetry in malaysian infants with cleft lip and palate.