Three-dimensional morphological study of craniofacial bones in non-syndromic cleft lip and palate patients based on cone-beam computed tomography imaging

Abstract

Background

Non-syndromic cleft lip with or without cleft palate (NSCL/P), including unilateral (UCLP) and bilateral (BCLP) types, is a common congenital deformity that affects maxillofacial appearance and function. In order to describe the postoperative craniofacial morphology in UCLP and BCLP patients after prior surgical intervention, this study used cone-beam computed tomography (CBCT) to quantify primary maxillofacial characteristics in UCLP and BCLP patients and to assess the secondary post-surgical changes in the maxillary bones.

Methods

This retrospective case-control study included 111 adolescents treated between January 2018 and December 2022. Participants were divided into three groups: UCLP (n = 37), BCLP (n = 37), and orthodontic control (n = 37). CBCT scans were obtained, and 3D reconstruction was performed using Mimics 21.0 software to establish a standardized coordinate system. Measurements of maxillary width, height, depth, and mandibular length were compared across groups using SPSS 26.0.

Results

In the UCLP group, maxillary width on the cleft side was significantly greater than in the control group, deviating from the midline (P < 0.05). The BCLP group showed a bilateral increase in maxillary width, with a greater distance from the cleft side maxilla to the sagittal plane (P < 0.05). Both cleft groups had significantly reduced maxillary height compared to controls (P < 0.05), indicating vertical underdevelopment. In the BCLP group, maxillary asymmetry was more pronounced, with inward displacement of key landmarks. Compared to the control, the cleft group showed no significant difference in mandibular length (P > 0.05), indicating it was unaffected by the cleft.

Conclusion

CBCT provides precise 3D measurements that reveal complex maxillary abnormalities in UCLP and BCLP patients, including width anomalies, vertical underdevelopment, and sagittal retrusion. The mandible remains unaffected in length, highlighting that the primary deformity lies in maxillary morphology rather than size. This study identifies distinct skeletal features for different CLP types, offering a foundation for individualized treatment planning and efficacy assessment.