Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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Dynamic Facial Asymmetry in Patients with Cleft Lip and Palate - What 4D Video Stereophotogrammetry Can Tell Us About Motion of the Repaired Lip
James R. Seaward, FRCS(Plast)1, Rami Hallac, PhD2, Alex A. Kane, MD1.
1University of Texas Southwestern Medical Center, Dallas, TX, USA, 2Children's Medical Center, Dallas, TX, USA.

PURPOSE:
Unilateral Cleft Lip is a profoundly asymmetrical condition affecting all hard and soft tissue layers from the nose to the upper lip. Although the asymmetry is minimized through cleft lip repair, nasal reconstruction and subsequent revision procedures as necessary, a degree of asymmetry inevitably persists. Studies investigating asymmetry in patients with Cleft Lip started with analysis of facial measurements and 2D photography, and more recently have moved to analysis of 3D photographs in static facial expressions. The nose / lip / mouth area, however, is rarely static in our day to day social interactions.
METHODS:
Non-syndromic patients with cleft lip and palate, and a control group of patients with isolated cleft palate underwent 60 frame per second 4D imaging while generating facial expressions including smiling and pouting, and while speaking. Key landmarks were tracked throughout the expression, corrected for head movement and a motion path of each landmark was generated. Asymmetry of the motion path was investigated using Procrustes analysis of the shape of the motion path.
RESULTS:
12 patients were compared in each group, with an age range from 8-18. Comparing the motion path of the Cupid’s Bow peaks from rest to maximal orbicularis oris contraction (pouting) demonstrated a mean asymmetry of magnitude of the motion path of 26% in the cleft lip group vs 9% in the control group and a mean asymmetry of the shape of the motion path itself of 0.055 in the cleft lip group vs 0.039 in the control group. These were both statistically significant results at p<0.05. Smaller asymmetry levels, which were not statistically significant, were identified for smile and speech.
CONCLUSION:
Video stereophotogrammetry of the repaired cleft lip demonstrates asymmetry of both the magnitude of motion as well as asymmetry of the path of the motion itself. This may be due to the effect of the scar tissue from the repair, from the abnormal anatomy involved with cleft lip or a combination of the two. The psychosocial impact of this asymmetry of motion on the individual remains unclear and we intend to investigate this further in due course.


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