Caries prevalence and enamel defects in 5- and 10-year-old children with cleft lip and/or palate: A case-control study

Objective. To determine the prevalence of dental caries and enamel defects in 5- and 10-year-old Swedish children with cleft lip and/or palate (CL(P)) in comparison to non-cleft controls. Materials and methods. The study group consisted of 139 children with CL(P) (80 subjects aged 5 years and 59 aged 10 years) and 313 age-matched non-cleft controls. All children were examined by one of two calibrated examiners. Caries was scored according to the International Caries Detection and Assessment System (ICDAS-II) and enamel defects as presence and frequency of hypoplasia and hypomineralization. Results. The caries prevalence among the 5-year-old CL(P) children and the non-cleft controls was 36% and 18%, respectively (p < 0.05). The CL(P) children had higher caries frequency (initial and cavitated lesions) in the primary dentition than their controls (1.2 vs 0.9; p < 0.05). A significantly higher prevalence of enamel defects was found in CL(P) children of both age groups and anterior permanent teeth were most commonly affected. Conclusions. Preschool children with cleft lip and/or palate seem to have more caries in the primary dentition than age-matched non-cleft controls. Enamel defects were more common in CL(P) children in both age groups.     

Assessment of dental anxiety using modified dental anxiety scale among adults with cleft lip and/or palate

ObjectivesThis study aimed to investigate dental anxiety levels among adults with cleft lip and/or palate (CL/P) and compare to adults with no orofacial cleft. The study also intended to find out the impact of cleft severity, gender and age on the perceived dental anxiety.MethodsThe study was composed of a sample of 70 adult participants who received and completed dental treatments. After sending self-addressed envelopes with consent forms and Modified Dental Anxiety Scale (MDAS) to 192 potential participants, 35 participants with CL/P (CL/P group) and 35 participants with no CL/P (control group), agreed to participate. Data were analysed using Mann–Whitney U test. A two-tailed P-value < 0.05 was considered as statistically significant.Results54.3% of adults with CL/P (23 females and 12 males, age range from 16 to 72 years) reported normal dental anxiety, while the remaining 45.7% reported moderate dental anxiety. No extreme dental anxiety were recorded in the CL/P group. These results were similar to the control group and there were no significant differences between groups (p > 0.05). Female participants recorded higher median anxiety scores than male participants in the CL/P group, and participants with cleft lip had higher median scores than participants with cleft lip and palate. However, these were not statistically significant.ConclusionThe results suggest that CL/P did not affect dental anxiety levels for participants with the CL/P as there were no extreme cases and their results were comparable to a general non-cleft sample.     

The morphology of sella turcica in cleft and non-cleft individuals

Aims and ObjectivesThe aim of the study was to analyze the morphology and expedient the linear dimensions of Sella Turcica among cleft and non-cleft Indian individuals, and then to determine whether differences exist between different study groups.Materials and methodsThe lateral cephalogram of 300 patients (150 cleft and 150 non-cleft), aged 18 to 30 years who reported for various treatments of malocclusions were studied.ResultThe normal morphology of the sella turcica were seen in 85 of the 150 non-cleft individuals which was highest (56.66%) in the non-cleft group, however in the cleft group it was seen in only 16 of the 150 individuals (10.6%). Sella turcica bridge were seen in 10% of the non-cleft subjects, whereas in the cleft group it was seen in 38% of the individuals. A significant difference was seen in the linear measurements of the sella turcica of cleft and no-cleft individuals.ConclusionThe normal morphology of the sella turcica was seen in the majority of the non-cleft individuals. The cleft individuals showed an increased incidence of sella turcica bridging with reduced linear measurements of the sella as compared to the non-cleft individuals.     

替牙期单侧完全性唇腭裂患者鼻上颌复合体对称性的锥形束CT研究

目的 探讨替牙期单侧完全性唇腭裂（unilateral complete cleft lip and palate, UCLP）患者鼻上颌复合体在三维方向上的对称性。方法 选择20例替牙期UCLP患者颅面部锥形束CT（CBCT）图像,运用Mimics 图像分析软件对骨组织进行三维重建,描记鼻根点及鼻上颌复合体健、患侧32个同名标记点,建立三维参考平面、分别测量32个点到三维平面的距离。采用SPSS 22.0 软件包对数据进行统计学分析。结果 在水平方向上,与非裂隙侧相比,裂隙侧点INM 、SPC处上颌骨的宽度小,点LPA、SPr处上颌骨宽度大,差异具有统计学意义（P<0.05)。在矢状方向上,与非裂隙侧相比,裂隙侧点LPA、Maz、SPr处深度大,点SPM、SPC处深度小,差异具有统计学意义（P<0.05)。在垂直方向上,裂隙侧点LPA、INM、Maz低于非裂隙侧,点SPC、SPr高于非裂隙侧,差异具有统计学意义（P<0.05)。其余各点均无统计学差异（P>0.05)。结论 替牙期UCLP患者鼻上颌复合体在三维方向上均不对称,不对称部位集中在鼻腔和牙槽骨处。眶部及远离裂隙的上颌骨区域未发现明显不对称。     

A non-language-specific speech test to evaluate the speech of cleft patients from different language and cultural backgrounds – A pilot study

Cleft speech tests are not universally available. We developed a tool to fill this gap, especially in the context of a cleft mission setting. We performed a pilot study to evaluate the test's ability to differentiate between the speech of cleft patients and healthy individuals from three different language backgrounds.We used 78 made-up, nonsensical syllables to evaluate hypernasality, nasal emissions, and consonant errors. Cleft (n = 41) and non-cleft (n = 39) individuals from three countries were included in this study. Two speech and language pathologists, blinded to the examination, rated the audio recording independently.Patients from Germany (n = 12; mean age 15.2), Iran (n = 14; mean age 7), and India (n = 15; mean age 14.7 years) were evaluated. We observed a significant difference in each category (p < 0.05) between patients and control subjects of the same language and cultural background. Hypernasality was affected the most.The test proved to possess the correct phonetic characteristics to reveal and provoke relevant cleft speech pathologies independent of cultural and language backgrounds. The test sounds posed no articulatory difficulties to non-cleft individuals, with some exceptions regarding non-specific consonant errors. A comparison with other existing tests will further illuminate its value as a speech test.     

Retrognathic maxilla in individuals born with oral clefts is due to intrinsic factors and not only due to early surgical treatment

ObjectivesTo determine if the skeletal form of individuals born with oral clefts was associated with maxillary position.Materials and MethodsLateral cephalometric radiographs of 90 individuals 8 to 12 years old born with or without cleft lip and palate paired by age and sex were used. Skull base length, cranial base angle, cranial deflection angle, and maxillary skeletal length and position were studied. Also, mandibular skeletal length and position, lower anterior facial height, and dental position were defined. Individuals were divided into three groups: 30 individuals born with cleft lip and palate with Class III malocclusion (UCLP Class III), 30 individuals born with cleft lip and palate with Class I malocclusion (UCLP Class I), and 30 individuals born without cleft lip and palate with Class III malocclusion (non-cleft Class III).ResultsWhen comparing the UCLP Class III group with the UCLP Class I group, there were differences in maxillary position (P < .001) and mandibular position (P = .004) found. No differences were found when comparing the UCLP Class III group with the non-cleft Class III group.ConclusionsThere are intrinsic factors that affect craniofacial morphology of individuals born with cleft lip and palate.     

BMP2 and BMP4 variations and risk of non-syndromic cleft lip and palate

ObjectiveNon-syndromic cleft lip with or without cleft palate (CL/P) is one of the most common congenital anomalies and arises from the interaction of environmental and genetic factors. The objective of this study was to investigate the association between the BMP2 (bone morphogenetic protein 2) and BMP4 (bone morphogenetic protein 4) polymorphisms with non-syndromic CL/P to clarify the potential role of these genes in the etiology of CL/P in Iranian population.DesignThe allelic and genotypic frequencies of BMP2 rs235768 A > T and BMP4 rs17563 T > C polymorphisms were determined in 107 unrelated Iranian subjects with non-syndromic CL/P and 186 control subjects using PCR and RFLP methods, and the results were compared with healthy controls. A p-value of <0.05 was considered statistically significant.ResultsThe BMP2 rs235768 AT genotype was significantly higher (P = 0.009, OR = 3, 95% CI = 1.3–7.0) in the CL/P (59.8%) than the control group (33.3%). Similarly, the BMP4 rs17563 TC genotype were significantly higher (P = 0.008, OR = 3.7, 95% CI = 1.4–9.9) in the CL/P (70.0%) than the control group (44.6%).ConclusionThe BMP2 rs235768 A > T and BMP4 rs17563 T > C polymorphisms could be considered as the risk factor for non-syndromic CL/P in Iranian population.     

单侧完全性唇腭裂患者前牙区牙槽骨开窗、骨开裂的锥形束CT研究

目的 利用锥形束CT（cone-beam CT,CBCT）研究单侧完全性唇腭裂（unilateral cleft lip and palate,UCLP）患者前牙区牙槽骨开窗、骨开裂的发生率。方法 选取2014年6月—2017年9月就诊于中南大学湘雅二医院的UCLP患者42例（男25例,女17例）。匹配性别和年龄,纳入42例骨性Ⅲ类非唇腭裂患者为对照组。利用CBCT评估UCLP组与对照组前牙区骨开窗和骨开裂的发生率,采用SPSS 22.0软件包对数据进行统计学分析。结果 裂隙侧、非裂隙侧及对照组前牙骨开裂发生率分别为50.88%、42.39%和28.77%。UCLP组裂隙侧上颌前牙同名牙骨开裂的发生率均显著高于对照组（P<0.05）,非裂隙侧上颌侧切牙骨开裂的发生率显著高于对照组（P<0.05）,裂隙侧上颌中切牙骨开裂发生率显著高于非裂隙侧（P<0.05）。裂隙侧、非裂隙侧与对照组前牙区骨开裂均好发于唇侧。骨开窗的发生率在裂隙侧、非裂隙侧及对照组间无显著差异（P>0.05）。结论 在UCLP患者中,牙槽骨开窗和骨开裂较常见,临床治疗中应引起重视。     

Bite force of children with repaired unilateral and bilateral cleft lip and palate

ObjectiveTo assess the bite force (BF) of children with repaired cleft lip and palate (CLP).DesignChildren aged 6–12 years, with and without CLP, were divided into the following 5 groups: (1) control group (CON): 34 children without CLP (17 female, 17 male, mean age 8.2 ± 1.4); (2) cleft lip group (CL): 31 children with cleft lip involving the pre-maxilla (15 female, 16 male, mean age 9.7± 1.3); (3) unilateral CLP group (UCLP): 36 children with complete unilateral CLP (11 female, 25 male, mean age 9.4± 1.6); (4) bilateral CLP group (BCLP): 32 children with complete bilateral CLP (11 female, 21 male, mean age 9.5± 1.7); and 5) cleft palate group (CP): 17 children with complete cleft palate (9 female, 8 male, mean age 9.4± 1.6). Briefly, in this clinical trial, BF was assessed before alveolar bone grafting with a gnathodynamometer (IDDK, Kratos, Cotia, SP, Brazil). For CON, BCLP, CL and CP groups, BF was obtained in the anterior and posterior region of the maxilla. For the UCLP group, BF was assessed in the anterior and posterior regions of both segments. Differences among groups were evaluated by ANOVA test, and Tukey’s test was used to assess any correlations among variables (P < 0.05).ResultsUnexpectedly, no differences of BF were observed among CON and any of the cleft groups. However, a stronger BF was observed in the CL group when compared to the UCLP and BCLP groups. Next, no differences were observed between the cleft side and the noncleft side in the UCLP group. Lastly, in all groups, BFs from the anterior region of the maxilla were less when compared to the posterior regions.ConclusionThe BF of children with CLP is no different from children without CLP.     

A cone beam computed tomographic evaluation of the size of the sella turcica in patients with cleft lip and palate

Objective: Changes in the size of the sella turcica are frequently related to pathologies and syndromes. The aim of this was to compare the sella turcica dimensions in patients with unilateral and bilateral cleft lip and palate and non-cleft subjects.

Methods: Cone beam computed tomography (CBCT) images of three groups consisted of 20 patients with unilateral cleft lip and palate; 20 patients with bilateral cleft lip and palate and a control group consisting of 20 non-cleft subjects were the research population in this pilot study. The sella turcica linear dimensions in terms of length, depth and diameter were measured for all subjects. One-way ANOVA test was used to determine any significant differences among the three groups for the measured parameters.

Results: The length, depth and diameter of sella turcica were found to be significantly smaller in the unilateral and bilateral groups compared with the normal age and gender matched group. No significant differences were found in the measured variables between the unilateral and bilateral cleft patients.

Conclusion: CBCT images showed a greater likelihood of abnormal sella turcica dimensions in patients with unilateral and bilateral cleft lip and palate. Therefore, the sella turcica dimensions may have an intrinsic relationship to the cleft condition.     

恒牙列早期唇腭裂修复术后患者下颌骨位置与形态的测量研究

目的：研究唇腭裂修复术对下颌骨形态和位置的影响。方法：选取21例非唇腭裂患者（非裂患者）作为A组（男10例,女11例,平均年龄13.10岁）,19例单侧唇腭裂伴牙槽突裂患者作为B组（男11例,女8例,平均年龄11.57岁）,17例双侧唇腭裂伴牙槽突裂患者作为C组（男10例,女7例,平均年龄12.50岁）。在正畸治疗前进行头影测量,分析下颌骨的形态和位置,使用SPSS17.0软件包对3组患者的测量数据进行独立样本t检验。结果：单侧唇腭裂患者与非裂患者在ANSMe、SNB、BaNPog和CoGo-MP存在显著差异（P〈0.05）,在CoGo、GoGn、CoGn、SGo和NMe也存在显著差异（P〈0.01）。双侧唇腭裂患者与非裂患者在GoGn和SN-MP存在显著差异（P〈0.05）,在SNB和CoGo-MP也存在显著差异（P〈0.01）。结论：唇腭裂修复术对下颌骨生长发育的影响主要表现在下颌骨矢状向位置偏后,下颌体长度减小,下颌支高度降低以及下颌骨向后、向下旋转。     

Oral health–related quality of life in Dutch children with cleft lip and/or palate

Objective:To investigate the oral health–related quality of life (OH-RQoL) of Dutch cleft lip and palate patients. It was hypothesized that (1) there is no difference between cleft patients'' and their parents'' reports of patients'' OH-RQoL; (2) there are no gender differences; (3) there are no differences in OH-RQoL between cleft patients with regard to their symptoms; and (4) there is no difference between patients above and below 12 years of age.Materials and Methods:The sample consisted of 122 patients with clefts (age range, 8–15 years) and their parents. Respondents were recruited from the cleft palate team of Amsterdam. They completed the Child Oral Health–Related Quality of Life questionnaire (COHIP). Items were divided into five different subscales, and scores on all subscales were compared between and within groups.Results:Patients'' and parents'' perceptions differed significantly on three of the five subscales. Girls and boys did not differ significantly with regard to their perception of reported OH-RQoL. The cleft lip and cleft lip and alveolus [CL(A)] subgroup scored significantly higher on the functional well-being subscale. The cleft patients aged 12 years and older scored significantly lower on the emotional well-being and oral symptoms subscales when compared with their younger peers.Conclusions:Only the second hypothesis was not rejected in this study. This means that parents are not interchangeable with regard to reporting on their children''s perceptions related to OH-RQoL, that OH-RQoL changes with age, and that it is important that subgroups are respected when investigating OH-RQoL in cleft patients.     

牙槽突裂植骨术后鼻外形的改变

目的：通过比较单侧牙槽突裂植骨手术前后鼻外形的变化,评价牙槽突裂植骨术在鼻畸形矫治中的作用。方法：通过人体学测量25例单侧牙槽突裂患者术前、术后即刻及随访6个月的外鼻形态,主要测量指标为健、患侧鼻孔宽度和高度,鼻翼基底宽度及两侧鼻翼基底连线与内眦连线的夹角,应用SPSS18.0软件包,对测得的数据进行配对t检验。结果：25例患者行牙槽突裂植骨手术后患侧鼻孔宽度为（11.61±2.18）mm,大于术前的（10.28±1.83）mm;高度为（4.52±1.19）mm,小于术前的（5.81±1.18）mm;患侧鼻翼基底均高于术前,与术前相比有显著差异（P〈0.01）。随访6个月后,虽形态有向术前回复的倾向,与术前相比仍有显著差异（P〈0.01）。结论：牙槽突裂植骨术后鼻翼基底的变化是植骨成功与否的一个重要指标,适量的超充填可弥补术后骨质吸收,为以后的鼻畸形整复提供一个对称的基底。牙槽突裂植骨后,鼻孔宽度和高度均有变化,故不主张在牙槽突裂植骨同期或之前行鼻畸形整复术。     

MMP gene polymorphisms as contributors for cleft lip/palate: association with MMP3 but not MMP1

OBJECTIVE: Orofacial clefts result from failures of developing embryonic facial and palatal processes to either completely merge or fuse. Normal development of the facial primordia requires remodelling of the extracellular matrix, which is mediated in part by the matrix metalloproteinases (MMPs). MMPs can be considered a group of candidate proteins for the etiology of cleft lip with or without cleft palate (CL/P) due to their role in craniofacial modelling. The purpose of this study was to determine if polymorphisms in MMP1 and MMP3 gene promoters were associated with CL/P. DESIGN: DNA was extracted from buccal epithelial cells and genotypes were obtained from CL/P cases and controls through PCR with allele-specific primers (MMP3, n=333) and restriction-fragment length polymorphism techniques (MMP1, n=395). RESULTS: Significant differences between cases and controls were observed for MMP3 [5A/6A allele frequencies (p=0.00001) and genotype frequencies (p=0.00001)]; and between cleft types and controls (p=0.00001 for CL/P; p=0.04 for CP). No significant differences were found for MMP1 allele and genotype frequencies between cases and controls or between cleft types and controls. CONCLUSIONS: An association between a polymorphism in MMP3 gene and CL/P has been observed. Although the extent to which this polymorphism may actually contribute to the affected cleft status is yet to be clarified, polymorphisms of MMP genes may be good candidates as genetic factors for their role in active ECM remodelling.     

Primary cheilorhinoseptoplasty using the Talmant protocol in unilateral complete cleft lip: functional and aesthetic results on nasal correction and comparison with the Tennison–Malek protocol

Many surgical procedures used to treat patients with unilateral complete cleft lip do not include a complete primary rhinoseptoplasty, which is delayed until the end of growth as part of secondary surgery. Primary cheilorhinoseptoplasty using the Talmant technique has been performed at Lapeyronie University Hospital, Montpellier for 15 years. This retrospective study evaluated and compared the functional and aesthetic results obtained in such patients at 4–6 years after surgery with those obtained without primary rhinoseptoplasty in patients undergoing the Tennison–Malek technique. This study included a cohort of 60 children who presented a unilateral complete cleft lip: 29 were operated on with the Tennison–Malek technique and 31 with the Talmant technique. Three functional and 14 aesthetic criteria were evaluated. All functional criteria showed better results in the Talmant group: nocturnal nasal breathing (P < 0.001), incidence of closed rhinolalia (P = 0.0019), and presence of asymmetric nasal breathing (P < 0.001). Concerning the aesthetic results, all criteria evaluated on the frontal and basal photographs of each patient showed significantly better results in the Talmant technique group. The rate of satisfactory results was> 75% for 12 of the 14 criteria in the Talmant group, compared with none of the 14 criteria in the Tennison–Malek group.     

Objective evaluation of vertical Z-plasty with double transposition vermillion flaps for secondary whistling deformity correction: A method for uni- and bilateral correction

ObjectivesThis study describes a modified method for secondary correction of whistling deformities in patients with unilateral and bilateral cleft lip/palate (CL/P), using a horizontal double transposition vermilion flap, including parts of the orbicularis oris muscle. The pre- and postoperative results were objectively evaluated.Study design34 patients with a whistling deformity who underwent secondary reconstruction between 07/2013 and 11/2018 were included in this study (mean age 20.2 ± 11.6 years). 24 patients were male and 10 female. 30 patients presented with cleft lip and palate (CLP) — 15 bilateral, nine on the left side and six on the right. Four patients had only a left-side cleft lip (CL).The whistling deformity reconstruction was carried out using two triangular transposition vermilion flaps with muscle parts, for a vertical Z-plasty. The surgical procedure is normally performed under local anesthesia in all patients older than 10 years. For statistical evaluation, the size of the whistling defect in the vermilion was determined on photographs before and 6–9 months after surgery. The individual defect score (DS) was evaluated pre- and postoperatively. In all patients, no additional surgical procedures, such as rhinoplasty or scar correction in the upper lip, were carried out simultaneously.ResultsMinor (DS < 400), moderate (DS 400–1400), and severe (DS > 1400) whistling defects were surgically corrected. The whistling defect score was significantly reduced in all patient groups (p < 0.001). In six patients the result of surgery was rated as 'acceptable' (DS > 30), in five patients as 'good' (DS 10–30), and in 23 patients as 'very good' (DS 0–10).ConclusionsThis study describes a modified method for whistling deformity reconstruction in uni- and bilateral clefts. The aesthetic results are based on a reconstruction of the subcutaneous muscle layers and the creation of a symmetrical lip contour and prolabium using transposition flaps from the lateral side of the cleft. The great advantage is the uncomplicated performance under local anesthesia, even for all children over 10 years, and the short operation time. Postoperative complications did not occur.     

3D Stereophotogrammetric assessment of pre- and postoperative volumetric changes in the cleft lip and palate nose

In cleft lip and palate patients the shape of the nose invariably changes in three dimensions (3D) due to rhinoplastic surgery. The purpose of this study was to evaluate stereophotogrammetry as a 3D method to document volumetric changes of the nose in patients with a cleft lip (CL) or cleft lip and palate (CLP) after secondary open rhinoplasty. 12 patients with unilateral CL or CLP were enrolled in the study prospectively. 3D facial images were acquired using 3D stereophotogrammetry preoperatively and 3 months postoperatively. A 3D cephalometric analysis of the nose was performed and volumetric data were acquired. The reliability of the method was tested by performing an intra- and inter-observer analysis. Left, right and total nasal volumes and symmetry were compared. No statistically significant differences (p < 0.05) were found within and between observers for the measured volumes and symmetry. Postoperatively, the total volume of the nose increased significantly, especially the volume at the cleft side. No significant volume difference pre- and postoperatively was found for the non-cleft side. The symmetry of the nose improved significantly. 3D stereophotogrammetry is a sensitive, quick, non-invasive method for evaluating volumetric changes of the nose in patients with cleft lip or cleft lip and palate.     

Nasolabial shape and aesthetics in unilateral cleft lip and palate: an analysis of nasolabial shape using a mean 3D facial template

The aim of this study was to determine the amount of deviation in nasolabial shape in patients with a cleft compared with an average non-cleft face, and to assess whether this difference is related to nasolabial aesthetics. Three-dimensional stereophotogrammetric images of 60 patients with a unilateral cleft were used. To quantify shape differences, four average non-cleft faces were constructed from stereophotogrammetric images of 141 girls and 60 boys. Three-dimensional shape differences were calculated between superimposed cleft faces and the average non-cleft face for the same sex and age group. Nasolabial aesthetics were rated with the modified Asher-McDade Aesthetic Index using a visual analogue scale (VAS). Mean VAS scores ranged from 51.44 to 60.21 for clefts, with lower aesthetic ratings associated with increasing cleft severity. Shape differences were found between cleft faces and the average non-cleft face. No relationship was found for the VAS, age, and sex, except that a lower VAS was related to a higher nose and lip distance between the superimposed cleft and average non-cleft faces for nasal profile (P =  0.02), but the explained variance was low (R² = 0.066). In conclusion, except for nasal profile, nasolabial aesthetics were not influenced by the extent of shape differences from the average non-cleft face.     

Facial and midfacial symmetry in cleft patients: Comparison to non-cleft children and influence of the primary treatment concept

Purpose

Patients with cleft lip, alveolus and palate (CLAP) may suffer from marked asymmetry with an impact on attractiveness and psychosocial aspects. The aim of this study was to assess symmetry in CLAP patients compared to non-cleft controls of similar age with regard to cleft type and treatment concept.

Postoperative lip and nose forms following primary bilateral cleft lip repair selecting one/two stage surgery in comparison to those of healthy children

PurposeTo analyze the short-term outcomes for the lip and nasal forms after primary treatment following our surgical strategy for bilateral cleft lip with/without palate (BCL ± P) repair selecting one- or two-stage surgery at Kagoshima University Hospital.Patients and methodsTwenty-one patients with BCL ± P were treated and followed up over 1 year (1–6 years). Patients underwent primary lip repair by one- or two-stage surgery depending on the prolabium height, medial-upward advancement of nasolabial components, and vestibular expansion using two cleft margin flaps. The postoperative lip and nasal forms were longitudinally measured using serial color photographs and were compared to those of 18 age- and sex-matched healthy Japanese children.ResultsPostoperative lip form showed the upper lip height and vermilion mucosal height were significantly increased compared with the preoperative values. The vermilion/cutaneous lip height ratio was improved to the same level as that of controls at 3 years of age. Symmetry of lip and nasal forms was successfully achieved postoperatively, but the nasal height was still smaller than that of controls.ConclusionsOur surgical management strategy for BCL ± P will provide well-balanced and symmetrical lip and nasal forms, except for the nasal height, without damaging an infant's prolabium.