Report of altered sensation in patients with cleft lip

Abstract

Objective: To determine whether patients with cleft lip have normal perioral sensation.

Design: Each subject was carefully questioned about the following: sensation in the face at rest, light touch of different areas, and sensation in natural situations (e.g., exposure to cold weather) that reveal sensory abnormalities. A cotton-tip applicator stick was stroked lightly across the facial skin. The subject's descriptions of the evoked sensations were used to identify and outline areas with abnormal sensation.

Setting: Data were obtained from subjects participating in a longitudinal, university-based study of the functional outcomes of lip revision surgery.

Patients: Seventeen patients with cleft lip and 12 control subjects (aged 7 to 22 years, mean 12.9 years) participated.

Results: In contrast to control subjects, 9 of 16 patients (56%) reported loss in sensation, described as decreased touch, scratch, tickle, or tingle intensity. Six other patients (38%) reported additional sensation, described as increased scratch, tickle, or tingle intensity. In eight patients, the altered sensation was restricted to the skin area flanking and including the visible scar, encompassing no more than 25% of the total area bound by the inferior nose, nasolabial grooves and inferior vermilion. In seven patients (unilateral cleft), the altered area extended to the contralateral, noncleft side of the upper lip or onto the philtrum.

Conclusions: In contrast to the literature, sensation in the upper lip of many patients with cleft lip is not normal. Loss in sensation is exhibited most commonly and limited largely to the skin overlying tissues traumatized during reconstructive surgery.

Figures

FIGURE 1

Areas of altered sensation in two of the eight patients for whom the mapped area was limited to the skin flanking and including the visible scar. A: A 16-year-old boy with bilateral cleft lip and palate. B: A 16-year-old girl with right unilateral cleft lip.

FIGURE 2

Areas of altered sensation in two of the seven patients with unilateral cleft for whom the mapped area extended contralaterally onto the noncleft side or the philtrum. The areas also extended onto the nose. A: A 21-year-old woman with right unilateral cleft lip and palate. B: A 10-year-old girl with a left unilateral cleft lip.

FIGURE 3

Repeated mapping by the same examiner of a 16-year-old female subject with a left unilateral cleft lip and palate. A: Quickly performed mapping with use of a dental explorer. B: More carefully performed mapping 2 weeks later with cotton-tip and wooden-stick stimuli.

FIGURE 4

Repeated mapping of a 16-year-old male subject with a left unilateral cleft lip and palate. A: First mapping by examiner G.E. B: Second mapping 3.5 months later by examiner C.D. See text for additional details.