Three dimensional Geometric Morphometrics Applied to Children with CLP

Objectives: This study investigated 3D facial morphological variation among and between groups of 8-12 year old children with UCLP, UCLA, BCLP, CP and a sex with age matched control group.

Design and setting: Prospective cross sectional geometric morphometric study with controlled capture of facial morphology using non invasive 3D stereophotogrammetry

Method: 3D images of 103 children with non syndromic operated CLP; 40 UCLP, 23 UCLA, 19 BCLP, 21 CP and 80 sex and age matched controls were taken at rest. 39 anthropometric landmarks were identified on each scan using MorphAnalyser software (Tiddeman et. al. 2000). The landmark coordinates of all groups were registered using Morphologika software (O'Higgins and Jones, 1998). Mean shape of each group was computed using generalised Procrustes and principal components analysis. Differences in shape between groups were assessed using MANOVA and shape differences were visualised for interpretation using warpings of the grand mean shape and transformation grids computed using thin plate splines.

Results: Statistically significant differences between all groups were found. Shape variation between the 5 group means was visualized, revealing that the greatest difference from the controls was in the groups with both lip and palate clefts an intermediate degree of difference was found in the cleft lip and alveolus group while the cleft palate group was the least affected group. The CP group was most similar to the control group followed by UCLA, and then BCLP. The greatest difference was in the UCLP group.

Conclusions: This outcome suggests that cleft lip and soft tissue lip repair has a greater effect on facial shape than cleft palate repair alone. These results emphasize the different aetiologies of the cleft palate and cleft lip and palate groups and underline the potential value of statistical shape analysis in assessing the outcomes of cleft lip and palate treatment.