Three-Dimensional Nasolabial Displacement during Movement in Repaired Cleft Lip and Palate Patients

Facial Soft Tissue Dynamics before and after Primary Lip Repair

“…This process located the exact camera positions and accounted for any geometric distortions in the camera lenses and accurately measured the camera lens focal lengths ( Cortex 3.0 Reference Manual , 2011). The error in specifying marker position within the system was determined previously (Trotman et al, 1998b; Trotman et al, 2000) and approximated 0.53 ± 0.45 mm. Then, the infant was positioned within the calibrated area and the cameras adjusted to focus on the face.…”

“…Using methods developed in our laboratory (Trotman et al, 2005; Trotman et al, 2007; Trotman et al, 2010; Trotman, 2011), the degree of improvement and/or further impairment due to revision surgery were visualized, and we were able to uncover unexpected factors that affect the dynamic facial aesthetics in patients with CL/P. For example, during certain animations (e.g., smiling), impaired movements in the upper lip were accompanied by lower lip compensatory movements as well as unusual, unaesthetic circumoral movements (Trotman et al, 2000; Trotman et al, 2005). …”

“…The analyses allow clinicians to objectively discriminate between normal and impaired facial movements, as well as normal and disfigured facial forms, in children and adolescents with repaired CL/P within an age range of 5 to 21 years. These metrics are intended as a supplement to surgeons’ subjective assessments (Gross et al, 1996; Trotman and Faraway, 1998; Trotman et al, 1998a; Trotman et al, 1998b; Trotman et al, 2000; Weeden et al, 2001; Trotman et al, 2003; Trotman et al, 2005; Trotman et al, 2007; Trotman et al, 2010; Trotman, 2011). Specifically, systematic and carefully designed studies revealed that in patients with repaired CL/P, circumoral movements are impaired, and the direction of the impairment tends to be related to the specific movement or animation action that a patient performs—a finding that reflects the underlying muscle anatomy and surgical scarring (Trotman et al, 2007; Trotman et al, 2010; Trotman, 2011).…”

Modification of Perioral Stiffness in Patients with Repaired Cleft Lip and Palate

“…Such abnormalities contribute to disorders of facial movement, oral continence, eating, speech production, and oral access (Stranc and Fogel, 1984; Trotman et al, 2000; Trotman et al, 2005). Trotman and coworkers (1998, 2000, 2005) found isolated and quantifiable areas of impaired circumoral soft tissue movements in patients with repaired cleft lip and palate that were related to the effects of the original cleft defect as well as the subsequent scarring that resulted from the primary or initial surgical repair of the lip.…”

“…Such abnormalities contribute to disorders of facial movement, oral continence, eating, speech production, and oral access (Stranc and Fogel, 1984; Trotman et al, 2000; Trotman et al, 2005). Trotman and coworkers (1998, 2000, 2005) found isolated and quantifiable areas of impaired circumoral soft tissue movements in patients with repaired cleft lip and palate that were related to the effects of the original cleft defect as well as the subsequent scarring that resulted from the primary or initial surgical repair of the lip. Studies on facial kinematics (Trotman et al, 2000; Trotman et al, 2005; Trotman et al, 2007a; Trotman et al, 2007b) support the possibility that in a child with a repaired cleft lip, abnormalities in the upper lip may influence the function of the lower lip.…”