Three-dimensional analysis of cleft palate topology in newborn infants with reference to the cranial skeleton

Objective: To describe a method of determining the three-dimensional topolo gy of the palatal crest relative to a reproducible anthropomorphic coordina te system in newborn infants with unilateral cleft palate. For this purpose , physical models of the maxilla and face were analyzed by computer morphom etry. Design: The study was limited to infants referred to the craniofacial; cent er during the first 11 days after birth, Setting: The study was performed at a craniofacial center servicing a large geographic area. Participants: The method was applied to 12 infants with unilateral cleft li p, alveolus, and palate (eight patients with left-side clefts and four with right-side clefts). Main Outcome Measures: The three-dimensional topology of the palatal crest referenced to an anthropometric coordinate system was the primary outcome m easure, The anthropometric reference system is defined by the tragus points and the midpoint of a line connecting the endocanthia. Results: The topology of the maxillary crests of the patients was character ized by considerable variability. The center of the premaxilla as defined b y the attachment of the frenulum was frequently displaced by several millim eters from the midsagittal plane. The displacement was to the left in infan ts with right-side clefts and to the right in infants with left-side clefts . The premaxilla can be rotated by more than 30 degrees relative to the nor mal position. No significant retroposition of the minor segment as determin ed by the location of the tuber points was found, Several morphometric anom alies were found to be correlated linearly. Conclusions: We propose that the morphologic deviations are in part caused by the neuromotor activity of the tongue and of the interrupted M. orbicula ris oris. The data can serve as the starting point for a longitudinal study of craniofacial development in children with cleft palate and for studies on the efficacy of different therapeutic approaches.