Multivariate analysis of second trimester midfacial morphology in normal and cleft lip and palate human fetal specimens.

To better understand the contribution of congenital dysmorphogenesis to postnatal midfacial dysplasia in individuals with complete cleft lip and palate (CLP), a series of studies were undertaken to investigate age related changes in a number of midfacial components for a sample of 20 normal and 9 complete CLP second trimester fetal specimens. Using data from this sample, the present study assessed the complex multivariate relationships among these variables which represent the fetal normal and CLP midface. Ten variables were standardized relative to crown-rump length and used in Canonical Discriminant Function Analysis (CDFA). CDF analysis revealed that five variables best described the midface and accounted for 72% of the overall variance. These included nasal capsule length, nasal airway volume, premaxillary length, premaxillary volume, and tongue volume. Classification using the CDFA coefficients resulted in correct group membership assignment for 26 of 29 total specimens (89.66%), 8 of 9 cleft (88.9%), and 18 of 20 normal specimens (90.0%). These results suggest that by as early as the second trimester CLP fetuses have a significantly distinct set of midfacial morphological relationships. Some or all of these factors may be responsible for postnatal growth dysplasias noted in CLP individuals.