Effects of lip revision surgery in cleft lip/palate patients

Abstract

The decision for lip revision surgery in patients with repaired cleft lip/palate is based on surgeons' subjective evaluation of lip disability. An objective evaluation would be highly beneficial for the assessment of surgical outcomes. In this study, the effects of lip revision on circumoral movements were objectively quantified. The hypothesis was that lip revision increases scarring and impairment. The study was a non-randomized clinical trial that included patients with cleft lip who had revision, patients with cleft lip who did not, and non-cleft control individuals. Three-dimensional facial movements were measured. Revision patients were measured before and after surgery. Other individuals were measured at similar intervals. Regression models were fit to summary measurements, and changes were modeled. Patients with repaired cleft lip/palate had fewer mean movements than control individuals. Lip revision did not worsen mean movements; however, individual patients' movements varied from 'improvement' to 'no change' to 'worse' relative to those of control individuals.

Figures

Figure 1.

Test sessions. Revision patients were tested twice before and twice after surgery. Non-revision and non-cleft participants were tested at corresponding times.

Figure 2.

The 44 landmark-pairs (denoted by a line connecting 2 markers) used to develop the measurements of movement. Markers are located at the average of the rest position for the control participants.

Figure 3.

Changes due to surgery for the revision patients. The solid diagonal line represents no change, while the 2 parallel diagonal dotted lines represent approximately 2 standard errors’ difference from no change. The horizontal and vertical lines represent the control group mean.