The assessment of facial asymmetry in patients with uni- or bilateral cleft lip and palate

Katarzyna Radwańska, Mateusz Radwański, Bogusław Antoszewski


Introduction: A cleft is a congenital defect involving a partial or complete disruption of continuity in the anatomical tissues in places associated with the embryological development of the face. The aim of the study was to assess the extent of facial asymmetry in patients with uni- or bilateral cleft lip and palate.

Materials and methods: Sixty-six patients with a cleft lip and palate (unilateral and bilateral) participated in the study. Three anthropometric measurements were examined: the length of the mandibular shaft (gonion-gnathion – go-gn), and the length (nostril anterius-nostril posterius – na-np) and width (nostril laterale-nostril mediale – nl-nm) of the nostrils. The diversity of asymmetry among the defect types and the relationship between sex, age, and type of cleft (bilateral vs. unilateral) were assessed against indicators of asymmetry. The data were statistically analyzed using Statistica PL (ver. 12, Statsoft, Poland).

Results: Patients with a unilateral and bilateral cleft presented an asymmetry of length and width of the nostrils. The sex and age of the patients and the type of cleft did not affect the asymmetry of the evaluated anthropometric parameters.

Conclusions: There was an asymmetry in the width and length of the nostrils, but the direction of this asymmetry had no relation to the location of the defect. The asymmetry of the width of the nostrils decreased with the age of the patient, regardless of the type of cleft. The cleft lip and palate (unilateral and bilateral) did not intensify the asymmetry of the length of the mandibular shaft. However, the direction of asymmetry in the length of the mandible was dependent on the side of the cleft – in unilateral clefts, the mandibular body usually had a slightly longer length on the healthy side of the face.


facial asymmetry; cleft lip and palate; anthropometric measurements

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Oinonen K, Mazmanian D. Facial symmetry detection ability changes across the menstrual cycle. Biol Psychol 2007;75(2):136-45.

Springer IN, Wannicke B, Warnke PH, Zernial O, Wiltfang J, Russo PAJ, et al. Facial attractiveness: visual impact of symmetry increases significantly towards the midline. Ann Plast Surg 2007;59(2):156-62.

Meyer-Marcotty P, Kochel J, Boehm H, Linz C, Klammert U, Stellzig-Eisenhauer A. Face perception in patients with unilateral cleft lip and palate and patients with severe Class III malocclusion compared to controls. J Craniomaxillofac Surg 2011;39(3):158-63.

Bardach J. Rozszczepy wargi górnej i podniebienia. Warszawa: Państwowy Zakład Wydawnictw Lekarskich; 1967.

Antoszewski B, Fijałkowska M. The prevalence of cleft lip and/or palate in children from Łódź in years 2001–2010. Pol Przegl Chir 2013;85(6):329-32.

Jagomagi T, Soots M, Saag M. Epidemiologic factors causing cleft lip and palate and their regularities of occurrence in Estonia. Stomatologija 2010;12(4):105-8.

Shapira Y, Lubit E, Kuftinec MM, Borell G. The distribution of clefts of the primary and secondary palates by sex, type, and location. Angle Orthod 1999;69(6):523-8.

Wójcicka K, Kobus K, Wójcicki P. Epidemiology of lip, alveolar process and palate clefts in the material of hospital and clinic of plastic surgery in Polanica Zdrój. Pol Przegl Chir 2009;81(1):4-11.

Antoszewski B, Fijałkowska M. Distribution of lip and/or palate clefts types among children form Lodz during years 1981–2015. Pol Przegl Chir 2018;90(3):1-6.

Antoszewski B, Fijałkowska M. Prevalence of cleft lip and/or palate in children from Lodz between years 1981–2010. Congenit Anom 2016;56(2):60-4.

Antoszewski B, Kruk-Jeromin J. Częstość występowania rozszczepów wargi i (albo) podniebienia u dzieci łódzkich w latach 1982–1991. Pol Merkur Lek 1997;3:10-2.

Antoszewski B, Kruk-Jeromin J. Częstość występowania rozszczepów wargi i/lub podniebienia u dzieci łódzkich w latach 1991–2000. Ann Acad Medicae Lodz 2002;43:13-6.

Birnbaum S, Ludwig KU, Reutter H, Herms S, de Assis NA, Diaz-Lacava A, et al. IRF6 gene variants in Central European patients with non-syndromic cleft lip with or without cleft palate. Eur J Oral Sci 2009;117(6):766-9.

Cobourne MT. The complex genetics of cleft lip and palate. Eur J Orthod 2004;26(1):7-16.

Kot M, Kruk-Jeromini J. Analysis of family incidence of cleft lip and/or palate. Med Sci Monit 2007;13(5):231-4.

Malinowski A, Bożiłow W. Podstawy antropometrii. Metody, techniki, normy. Warszawa: Wydawnictwo Naukowe PWN; 1997.

Swaddle JP, Witter MS, Cuthill IC. The analysis of fluctuating asymmetry. Anim Behav 1994;48(4):986-9.

Hoh E, Sulaiman W. Analysis of preoperative measurements in unilateral cleft lip patients toward the outcome of secondary cleft deformities. J Cleft Lip Palate Craniofac Anomal 2019;6(2):93-8.

Meyer-Marcotty P, Alpers GW, Gerdes ABM, Stellzig-Eisenhauer A. Impact of facial asymmetry in visual perception: a 3-dimensional data analysis. Am J Orthod Dentofacial Orthop 2010;137(2):168.e1-8.

Abuhijleh E, Aydemir H, Toygar-Memikoğlu U. Three-dimensional craniofacial morphology in unilateral cleft lip and palate. J Oral Sci 2014; 56(2):165-72.

Kurt G, Bayram M, Uysal T, Ozer M. Mandibular asymmetry in cleft lip and palate patients. Eur J Orthod 2010;32(1):19-23.

Choi YK, Park SB, Kim YI, Son WS. Three-dimensional evaluation of midfacial asymmetry in patients with nonsyndromic unilateral cleft lip and palate by cone-beam computed tomography. Korean J Orthod 2013;43(3):113-9.

Capelozza Filho L, Normando ADC, da Silva Filho OG. Isolated influences of lip and palate surgery on facial growth: Comparison of operated and unoperated male adults with UCLP. Cleft Palate Craniofac J 1996;33(1):51-6.

da Silva OG Jr, Normando AD, Capelozza L Jr. Mandibular morphology and spatial position in patients with clefts: intrinsic or iatrogenic? Cleft Palate Craniofac J 1992;29(4):369-75.

Feijo MJF, Brandão SR, Pereira RMR, Santos MB, da Silva HJ. Nostril morphometry evaluation before and after cleft lip surgical correction: clinical evidence. Int Arch Otorhinolaryngol 2014;18(2):192-7.

Linden OE, Taylor HO, Vasudavan S, Byrne ME, Deutsch CK, Mulliken JB, et al. Three-dimensional analysis of nasal symmetry following primary correction of unilateral cleft lip nasal deformity. Cleft Palate Craniofac J 2017;54(6):715-9.


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