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Condylar Volumetric Asymmetry Predicts Need for Surgical Intervention in Patients With Cleft Lip and/or Palate
Dominic J Romeo1, Kaan T Oral, Isabel A Ryan
1Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA.
Objective:
In this study, the authors investigate the associations between the mandibular condyle and facial asymmetry in patients with cleft lip and/or palate (CLP).
Methods:
Condylar volume was calculated by measuring the bony volume of the posterior mandible superior to the sigmoid notch in skeletally mature patients with CLP and controls. Relationships between condylar asymmetry, facial deviation, and malocclusion were compared using t-tests, correlation analysis, and receiver operating characteristic curves.
Results:
This study included 118 patients: 60 with CLP preparing for orthognathic surgery, 17 with CLP who did not undergo orthognathic surgery, and 41 controls. Condylar volumes in patients with CLP preparing for orthognathic surgery were more asymmetric than those with CLP not requiring surgery (16.4 ± 17.4% vs 7.1 ± 6.0%, P = 0.03). Patients with CLP who did not undergo orthognathic surgery and controls had similar degrees of condylar asymmetry (7.1 ± 6.0% vs 5.9 ± 3.8%, P = 0.35). Condylar asymmetry correlated with chin deviation ( P < 0.01). Patients with CLP and clinically significant chin deviation (>4 mm) had more asymmetric condyles than those without significant chin deviation, and the chin usually deviated toward the smaller condyle ( P = 0.03). Condylar asymmetry >11% predicted undergoing orthognathic surgery in CLP with 70% sensitivity and 67% specificity.
Conclusion:
Condylar asymmetry is associated with facial asymmetry in patients with CLP, and the facial midline often deviates towards the smaller condyle. Condylar volumetric asymmetry in patients with CLP may be a predictor for needing orthognathic surgery, useful information for surgeons and families alike.
