Palatal subunits analysis in unilateral cleft lip and palate compared to controls: A comparative cohort study

It is essential to objectively evaluate how a unilateral complete cleft lip and palate (UCLP) alters palatal anatomy. This study defines palatal subunits, to assess tissue changes in distinct anatomical areas of the palate. Additionally, we describe the changes after passive presurgical plate therapy.

The palates of 21 newborns with non-syndromic UCLP were analyzed using 3D scans at two time points: post-birth (T1) and before primary surgery (T2). Subunits were defined as the premaxilla, alveolar crests, palatal segments, vomer, and true cleft. A control group of 17 age-matched infants with intact palates at T2 was included for comparison. Landmarks and coordinate systems were employed for linear and surface measurements.

At T2, patients with cleft showed a total palatal surface area that was 8.04% smaller compared to those in the control group (p=0.015). The premaxilla was 15.94% larger in the study group than in the control group at T2 (p=0.024). Tuberosity and canine width were 12.95% (p<0.001) and 7.16% (p=0.012) larger, respectively, in patients with cleft at T2 compared to the controls. The true cleft area decreased by 43.18% (p<0.001) from T1 to T2. Anterior cleft width decreased by 35.48% (p=0.002).

This anatomical subunit analysis provided a distinct understanding of UCLP morphology and how it responds to treatment. It revealed important regional differences, such as the larger, variable premaxilla and primary deficiency in the palatal-maxillary fibromucosa of the cleft side. These findings support subunit-based assessments as valuable tools for diagnostic, personalized treatment and future 3D research in cleft care.