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Published on: November 4, 2025
Preoperative osseous dysmorphology in unilateral complete cleft lip and palate: a quantitative analysis of computed
Alex A Kane1, Valerie Burke DeLeon, Christopher Valeri
1St. Louis, Mo.; Baltimore, Md.; University Park, Pa.; and Taipei, Taiwan, R.O.C. From the Washington University School of Medicine; Johns Hopkins University School of Medicine; Pennsylvania State University; and Chang Gung Memorial Hospital.
Insights
Infants with unilateral cleft lip and palate show significant facial bone asymmetry. This asymmetry affects not only the cleft area but also distant skull regions, impacting overall craniofacial development.
Area of Science:
- Craniofacial surgery
- Pediatric plastic surgery
- Medical imaging analysis
Background:
- Infants with unilateral complete cleft lip and palate present with craniofacial abnormalities.
- Quantifying preoperative osseous dysmorphology is crucial for understanding developmental impact.
Purpose of the Study:
- To quantitatively assess preoperative osseous dysmorphology in 3-month-old infants with unilateral complete cleft lip and palate.
- To evaluate the extent and pattern of craniofacial asymmetry.
Main Methods:
- High-resolution computed tomography (CT) scans of 28 infants were analyzed.
- Surface-rendered reconstructions and 43 skull landmarks were used.
- Euclidean distance matrix analysis quantified asymmetry between cleft and noncleft sides.
Main Results:
- Primary and secondary landmarks showed significant asymmetry, with greater distances on the cleft side.
- Subtle but significant asymmetries were observed in tertiary landmarks (1-5%).
- Specific landmarks (nasion, zygomaxillare superius, frontozygomatic junction) and cranial base regions exhibited significant differences.
Conclusions:
- Cleft-related displacement explains major asymmetries.
- Subtle asymmetries in tertiary landmarks suggest a global effect on facial development.
- CT-based Euclidean distance matrix analysis is effective for quantitative morphometry in cleft patients.
Background:
The purpose of this study was to quantitate preoperative osseous dysmorphology in a homogeneous group of 3-month-old infants with unilateral complete cleft lip and palate.
Methods:
High-resolution computed tomography scans of 28 infants with unilateral complete cleft lip and palate were the basis for study. Coordinate data from 43 landmarks on the skull were collected using surface-rendered reconstructions of scan data. Euclidean distance matrix analysis was used to assess the degree of asymmetry between the cleft and noncleft sides of the craniofacial skeleton.
Results:
Linear distances involving primary and secondary landmarks (those that are located on or within the bony cleft and those that are near the cleft in the adjacent oronasal area, respectively) were highly asymmetric, with significantly greater distances on the cleft side. In addition, small (1 to 5 percent) but statistically significant asymmetries in linear distances were found involving tertiary landmarks (those that are not directly associated with the cleft or adjacent oronasal area). Most linear distances involving the nasion, zygomaxillare superius, and frontozygomatic junction were significantly greater on the cleft side, and certain linear distances in and around the middle cranial fossa were significantly smaller on the cleft side.
Conclusions:
The extreme asymmetry of primary and secondary landmarks is explained by the cleft itself and the obvious displacement of the premaxilla toward the noncleft side. The subtler, statistically significant asymmetry of the tertiary landmarks supports the idea that the unilateral cleft affects development of the entire face and possibly the cranial base. Euclidean distance matrix analysis of computed tomography landmark data is a useful methodology for the quantitative morphometry of children with untreated unilateral cleft lip and palate.
