Facial soft tissue dynamics before and after primary lip repair.

Objectives :  (1) To collect three-dimensional, dynamic facial images from two groups of infants: one group born with cleft lip and palate slated to have a primary lip repair and a second, age-matched, noncleft control group. (2) To develop analyses to determine differences in facial movement between infants with cleft lip with or without palate (CL±P) and noncleft control infants and to determine changes in facial movement before and after primary lip repair. Design :  Longitudinal, prospective case-control study. Setting :  Facial Animation Laboratory at the University of North Carolina School of Dentistry. Participants :  Two groups of infants: one group with unrepaired CL±P slated to have primary lip repair (n = 15) and a second group of age-matched, noncleft controls (n = 15). Interventions :  Movement testing before and 4 months after primary lip repair in infants with CL±P and at similar time points in noncleft infants. Main Outcome Measures :  Seven measures of facial movement. Results :  The range of facial movements increased by 17% for all infants during the 4-month period. Compared with the noncleft group (1) infants with unilateral CL±P had 50% less nasolabial movement, and this difference did not change due to the lip repair; and (2) infants with unilateral or bilateral CL±P had 58% and 118% greater lateral upper lip movement, respectively, and 3.67 and 3.56 times greater asymmetry of movement, respectively, before lip repair. The procedure almost entirely removed the hypermobility and decreased the asymmetry. Conclusions :  Primary surgical lip repair decreased hypermobility and improved asymmetry of upper lip movement.