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The three-dimensional coordinates of 23 selected soft-tissue facial landmarks were digitized on 18 cleft lip and palate (CLP) white patients (11 male and 7 female patients aged 19-27 years) and 161 healthy controls (73 female and 89 male subjects aged 18-30 years) by an electromagnetic instrument. Facial asymmetry was quantified by detecting a plane of symmetry and the centers of gravity (CG) of the right and left hemifaces and by calculating the distance between the two CG (distance from symmetry [DFS]). Both absolute (millimeters) and percentage (of the nasion center of gravity distance) DFS was obtained. The asymmetry of single landmarks was also quantified. Overall, asymmetry in operated CLP patients appeared only moderately larger than that measured in the healthy reference population, with the largest value being only 5% larger than the maximum normal asymmetry. Female patients had a somewhat larger lateral asymmetry than male patients, and unilateral CLP patients (particularly the men) were more asymmetrical than bilateral CLP patients. Pronasale and subnasale landmarks were asymmetrical in 8 patients, whereas endocanthion, zygion, cheilion, and gonion landmarks were symmetrical in all patients. In conclusion, the facial soft-tissue structures of CLP patients operated on as adults were only moderately more asymmetrical than those measured in a reference group of the same age, sex, and ethnicity.

Measurements were taken from 18 patients operated on for cleft lip and palate, aged 19 to 27 years, and 162 control subjects matched for sex, age, and ethnic group. Nine soft-tissue landmarks on the lips were digitized by a three-dimensional electromagnetic instrument. From the landmarks, several linear distances (mouth width, philtrum width, vermilion height of upper and lower lip, total vermilion height, total lip height), the interlabial angle, and some areas (vermilion of upper lip, vermilion of lower lip, total vermilion) and volumes (upper lip volume, lower lip volume, total lip volume) were calculated. Patient and reference data were compared by t tests and Watson-Williams tests. In the men, significant differences (p < 0.05) were found in width of the philtrum, height and area of the vermilion part of the upper lip, and total vermilion height and area (all larger in male patients than in controls). In the women, significant differences were found in the height and area of the vermilion part of the upper lip (larger in female patients than in controls), and in the height and area of the vermilion part of the lower lip (smaller in patients than in controls). In both sexes, the interlabial angle was smaller than in the reference population. In conclusion, the upper lip of adult patients operated on for cleft lip and palate differed from that of healthy controls of the same age, sex, and ethnic group. Surgical correction of cleft lip and palate failed to provide a completely normal appearance. The analysis pointed out those parts of the lips and mouth (in particular, the vermilion part of the upper lip) that differed the most from the norm. The method may be used to indicate to the surgeon and patient where additional procedures might be performed to approximate the morphologic characteristics of a reference population.