Craniofacial morphology in adults with bilateral complete cleft lip and palate

Cephalometric x-ray studies were carried out on 26 adult males with complete bilateral cleft lip and palate (BCLPc) and 50 non-clefts. The configuration of the neurocranium and cranial base showed no substantial differences. Facial differences were similar to those in unilateral clefts (UCLPc). Protrusion and retroinclination of the premaxilla affected the depth and height of the upper jaw and thus the total height and posterior growth rotation of the face. Thus the depth of the maxillary complex was unchanged, while the depth of the posterior maxilla was reduced, as in UCLPc. The increased length of the face, its posterior growth rotation, the dentoalveolar maxillary retroinclination and the displacement of the maxilla backwards were all more marked in bilateral clefts then in unilateral clefts. Changes of mandibular shape, an enlarged interocular distance, retrusion of the upper jaw and the configuration of the soft tissue profile, including the shorter upper lip were identical in both forms of clefts. However the mandible was more retrognathic and posteriorly rotated in bilateral clefts. The skeletal profile was not flattened, but the palatal plane was retroinclined and the depth of the nose was increased. BCLPc was associated with a widening of the nasal cavity and a thinner upper lip. The dimensions of the nasopharyngeal skeletal framework were reduced. The retrocheilia was conspicuous. Premaxillary setback resulted in a reduction of the depth of the upper jaw, of the height of the upper face and of the dentoalveolar retroinclination of the maxilla.