Evaluation and Comparison of Craniofacial Morphology of Unilateral Cleft Lip


Growth of craniofacial component is not an isolated event but is related to other parts. No craniofacial component is developmentally self-contained and self-retained. In fact growth is a composite change of all components. It has been speculated that most of the craniofacial anomalies, commonly the cleft lip and cleft palate affects the growth of craniofacial bones. However, the exact impact of cleft lip and palate in the development of cranial base, maxilla and mandible collectively remains uncertain. The patients with cleft need multiple surgical corrections since infancy, this shows considerable inhibition in the anteroposterior as well as transverse development of the midface after completion of growth. Hypoplasia and extrusion of the maxilla is a commonest finding in cleft patients. To evaluate the correlation of maxilla and mandible and then with the cranial base enlow with Moyers, Hunters and McNamara proposed “Counterpart Analysis” (CPA) to explain how a particular growth pattern is produced in any individual. Counterpart analysis states that the development of various craniofacial bones relays specifically with the supplementary structural and geometrical equivalents in the face and cranium. This procedure provides a mean by which principle anatomic components of the craniofacial complex of an individual can be compared with one another to evaluate balance of their anatomic fit. The correlation of one bone with other bone can be assessed which is useful in planning orthographic surgeries. Multiple surgeries and fibrous tissue and inherent deficient growth potential of maxilla in UCLP tends to fall in surgical treatment option. Mandible in cleft usually being normal though has a class III pattern with mandibular pragmatic appearance. Therefore an understanding of differences and similarities in growth of craniofacial bones in patients with UCLP with that of normal class I cases is utmost important to understand the variations of class III that appeared in cleft. The hypoplastic maxilla in cleft seen with similar features to that of class III cases has its varied etiology, thus the treatment strategy should also vary. There are numerous studies in the literature where the correlation of maxilla, mandible and cranial base, effects of surgeries on maxilla and its counter effect on mandible has been analyzed. But use of counterpart analysis in assessing individuals of unilateral CLCP is being done rarely. An observational cross sectional study was there by planned to evaluate craniofacial morphology in UCLP cases by counterpart analysis and to compare it with class I and class III cases with an hypothesis that the anterior divergence and concave profile in cleft and class III may have different etiological basis as the morphology in UCLP may vary than the skeletal class III individuals The study was done in the department of orthodontics and dentofacial Oorthopedics. The spreadsheet chart which calculates sample size for different p values, lamorte power calculations was used. For this the estimated means and standard deviations for each groups are given. The sample size for each group was Fig. 1. Landmarks. Fig. 2. Planes traced for study. Fig. 3. Showing regional dimension and alignment. The tracing and analysis using the landmarks was done twice by the same observer at an interval of 1 week on a new tracing sheets and new markings to avoid the bias in the study. The data obtained was statistically analyzed by using reliability test Cronbach’s method of reliability; the values more than 0.75, were considered reliable. The values obtained were subjected to statistical analysis using descriptive and inferential statistics using, one way ANOVA, Student’s unpaired t test and multiple comparison by Banferroni Test. Continuous variables were presented as mean ± SD.