Comprehensive Smile Component Analysis in Unilateral Cleft Lip and Palate Using Akhter-Anne Framework

ObjectiveThis study aimed to comprehensively compare smile aesthetics between surgically corrected unilateral cleft lip and palate (CUCLP) patients and non-cleft controls, evaluating multiple facial domains to identify persistent deficits.DesignA cross-sectional, comparative study was conducted.SettingThe study was performed in a clinical research setting.Patients/ParticipantsThe cohort consisted of 30 CUCLP patients who had undergone surgical repair and 30 age- and sex-matched non-cleft controls, all aged between 16 and 30 years.InterventionsThe intervention for the patient group was prior surgical correction of CUCLP; no new intervention was administered as part of this observational study.Main Outcome Measure(s)Standardized frontal photographs were analyzed using MAKHTER software and the Akhter-Anne Smile Diagram. Key parameters measured across facial, nasal, labial, nasolabial, and dento-gingival domains included nasal width, commissure width, philtrum height, lip length, and incisor display.ResultsThe facial component showed no significant differences. However, CUCLP patients exhibited significant deficits in other domains: reduced philtrum height (0.58 ± 0.21 mm vs. 0.84 ± 0.31 mm; p = 0.004), shorter upper lip length (0.42 ± 0.14 mm vs. 0.62 ± 0.22 mm; p = 0.001), and narrower commissure width (4.23 ± 0.52 mm vs. 6.95 ± 0.90 mm; p < 0.001). Nasal width was reduced (3.25 ± 0.40 mm vs. 4.56 ± 0.54 mm; p < 0.001) with pronounced nasolabial asymmetry. Dento-gingivally, maxillary incisor show was less (1.80 ± 0.54 mm vs. 3.45 ± 0.63 mm; p < 0.01) while mandibular incisor display was greater (2.75 ± 0.48 mm vs. 1.25 ± 0.36 mm; p < 0.05).ConclusionsDespite surgical repair, CUCLP patients have persistent esthetic impairments, particularly in the nasolabial and dento-gingival regions. A structured, multi-domain smile analysis is crucial for guiding multidisciplinary treatment to optimize final aesthetic and psychosocial outcomes.