Features of Morphometric Characteristic of Craniofascial Area of Children with Congenital Cleft Lip and Palate

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Volume 5 Issue 6, September-October 2021 Available Online: www.ijtsrd.com e-ISSN: 2456 – 6470 
 
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Page 1111 
Features of Morphometric Characteristic of Craniofascial 
Area of Children with Congenital Cleft Lip and Palate 
Kambarova Shakhnoza Alikhuseinovna 
Assistant of Surgical Dentistry Department, Bukhara State Medical Institute, Uzbekistan 
 
ABSTRACT 
For the effective comprehensive treatment of children with 
congenital cleft lip and palate (CCLP), it is necessary to periodically 
study the dynamics of growth of mandible segments. The 
development and growth of the nasal and maxillary complex in 
patients with CCLP is a widely discussed topic in any surgical 
procedure. The study of the growth, development and condition of 
the child's facial skeleton can be a theoretical and methodological 
basis for the development and improvement of anthropometric 
methods of diagnosis and reconstruction in medicine, the 
substantiation of new principles for the prevention and treatment of 
dental abnormalities. Accounting for facial proportions is important 
in surgical, orthodontic dentistry. In this regard, specialists in surgical 
dentistry are interested in measuring individual facial dimensions. 
 
 
KEYWORDS: craniofacial region, congenital cleft lip and palate 
 
 
 
 
 
 
 
 
 
 
 
 
How to cite this paper: Kambarova 
Shakhnoza Alikhuseinovna "Features of 
Morphometric 
Characteristic 
of 
Craniofascial Area of Children with 
Congenital Cleft Lip and Palate" 
Published 
in 
International 
Journal of Trend in 
Scientific Research 
and Development 
(ijtsrd), 
ISSN: 
2456-6470, 
Volume-5 | Issue-6, 
October 2021, pp.1111-1117, URL: 
www.ijtsrd.com/papers/ijtsrd47598.pdf 
 
Copyright © 2021 by author (s) and 
International Journal of Trend in 
Scientific Research and Development 
Journal. This is an 
Open Access article 
distributed under the 
terms of 
the Creative Commons 
Attribution License (CC BY 4.0) 
(http://creativecommons.org/licenses/by/4.0) 
 
Actual. Congenital cleft of the lip and palate (CCLP) 
is one of the common anomalies of the development 
of maxillofacial region. According to statistical 
studies, the prevalence of congenital cleft of the upper 
lip and (or) palate (CCLP) in newborns remains high 
(1-2 cases per 1,000 newborns) [1]. 
A family history can be found in about 40% of cases, 
although the actual genetic factors of cleft lip and 
palate are extremely complex. Commonly cited 
statistics say that the risk of unaffected parents having 
a second child with an anomaly is about 1 in 20. 
Etiology of multiple factor cleft anomalies. Some 
environmental factors, such as phenytoin taken during 
pregnancy, increase the risk of cleft lip and palate, 
and other medications (e.g. retinoids), folic acid 
deficiency, and fetal alcohol syndrome also increase 
morbidity. It has been shown that taking folic acid 
reduces the incidence. 
It is believed that the cleavage mechanism is 
associated with impaired fusion of the embryological 
processes that make up the upper lip at the sixth week 
of intrauterine life. A hard and soft palate is formed 
by another mechanism. The described process is the 
"reversal" of palatine tissue from a vertical position to 
a horizontal position, followed by merging, to form a 
secondary palate at about the eighth week of 
intrauterine development. Lack of growth, disruption 
of the coup process or destruction of the overlying 
epithelium, allowing the flow of the mesenchyma to 
create a strong structure, can lead to cleavage of the 
palate. 
Cleft lips and palates are more common in boys than 
in girls, and more often affect the left side. Cleft is 
often more serious if it occurs in a less common 
version (that is, in the girl and on the right side). 
Statistics on the prevalence of cleft lip and palate vary 
widely, both geographically and among different 
racial groups (Asian population - about 1 in 425 live 
births; African-Caribbean population - 1 per 3,000 
live births). 
One suggestion that explains why isolated cleft palate 
is more common in girls than in boys is that since the 
process of rearranging palatine tissues occurs later in 
the female fetus than in the male fetus, there is a 
greater potential for environmental exposure. [2] 
 
 
IJTSRD47598 
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Study methodology: Modern scientific literature was 
used as material. 
Results and discussion: "A healthy mother is a 
healthy child," the State program "Year of a healthy 
child" is carrying out large-scale work aimed at 
further strengthening the reproductive health of the 
population, strengthening the material and technical 
base and personnel capacity of medical institutions 
providing medical assistance in the field of maternal 
and child health care, and introducing modern 
methods for the diagnosis, treatment and prevention 
of diseases of women, children and adolescents. [3] 
CCLP occurs as a result of impaired morphogenesis 
[4]. 
At the end of week 4 of intrauterine development, a 
deepening of the ectoderm, called the mouth bay 
(fossa), which is the primary oral cavity, occurs in the 
area of   the head end of the embryo. Around the 
same time, 5 pairs of gill pockets form on the lateral 
walls of the pharyngeal part of the primary intestine. 
Between the gill pockets are gill (visceral) arcs. The 
first pair of gill arches is called jaw due to the fact 
that in the future it is divided into maxillary and 
mandible processes. At first, the oral bay is 
represented by a narrow slit, from above it is limited 
by the frontal process, and from below and from the 
sides by the maxillary and mandible processes. At 5-6 
weeks of intrauterine development, olfactory pits 
appear on the frontal process. The frontal process 
wedges between the maxillary processes and forms 
the medial and lateral nasal processes. External nose, 
nasal septum and primary palate are formed from 
nasal processes. The primary sky has the shape of a 
triangle, in the following; the front part of the solid 
sky is formed from it, which includes an alveolar 
process containing four upper incisors. At week 6 of 
embryogenesis, the maxillary and nasal processes 
fuse together as a result of their intense growth, 
forming the lateral part of the upper jaw and upper 
lip. As a result of the merger of the medial nasal 
processes, the middle part of the upper jaw and upper 
lip (filtrum) is formed. Maxillary elevation cells are 
mixed with mesenchymal cells of the intercellular 
segment, at which time all segments of the upper lip 
merge. From mesenchymal cells, connective and 
muscle tissues are further formed. In the embryonic 
period of development, the cleft of the upper lip 
almost always accompanies the cleft of the primary 
palate. However, more often the congenital cleft of 
the upper lip and alveolar process is formed as a 
result of disruption of the fusion of the medial nasal 
and maxillary processes. By week 8-9, the 
development of the primary sky ends and the 
development of the secondary sky begin. The 
secondary palate is formed from palatine processes 
located on the medial surfaces of the maxillary 
processes. As they approach each other, they move 
the tongue forward and downward. Subsequently, the 
palatine processes merge between each other and the 
lower edge of the nasal septum. Thus, by week 10, 
the bone part of the premaxilla of the upper jaw and 
palate is formed. By week 12 of embryogenesis, the 
development of the soft palate and palatine tongue is 
completed as a result of the proliferation of 
mesenchymal cells in the posterior parts of the 
palatine processes. Thus, when the fusion of palatine 
processes is disturbed, a congenital cleft of the palate 
is formed [5]. 
Foreign literature describes a work in which a group 
of scientists autopsied 6 stillborn children with a one-
sided through cleft of the upper lip and palate. The 
object of their interests was the cartilage of the nose. 
Autopsy results showed that in all cases there was 
asymmetry of the cartilaginous wings of the nose, 
deformation was noted on the cleft side, and also in 
all children a shift of the nasal septum was detected in 
the healthy side. In addition to comparing the shape 
and size of the cartilage of the two nasal halves, they 
evaluated and compared the weight of the wing 
cartilages. There was no reliable data for the 
difference in the weight of the cartilage wing of the 
nose on the healthy side and on the cleft side, this 
served as a reason to argue that the asymmetry of the 
nose wings in children with CCLP is the result of 
cartilage deformation, and not their hypoplasia [6].  
Children with CCLP have hypertrophy of the lower 
nasals. With a unilateral cleft of the sky, the process 
is one-sided. The severity of hypertrophy directly 
depends on the degree of cleft palate, so in children 
with partial cleavage of the palate there is 
hypertrophy only of the posterior ends of the lower 
nasal shells. According to the literature with this 
congenital pathology, changes in the motor and 
respiratory function of the atrial epithelium of the 
nasal mucosa are noted [7]. 
During 
the X-ray examination of children 
(radiography, computed tomography of paranasal 
sinuses), some of the patients examined showed 
asymmetry of the maxillary sinuses. In children with 
a unilateral through cleft of the upper lip and palate, 
the sinus volume was larger on the side of the lesion. 
Asymmetry of maxillary sinuses in this case was 
explained by violation of sinus pneumatization as a 
result of nasal mucosa inflammation and nasal septum 
curvature preventing adequate sinus ventilation [8]. 
Analysis of head computed tomography data shows 
that size of nasopharynx in children with CCLP is 
smaller than in healthy children, decreased size of 
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skull base in middle cranial fossa area and height of 
wedge-shaped bone body was observed [9]. 
It was found that in patients with CCLP, the angle 
between the attachment of muscles m. tensor veli 
palatini, the lateral plate of the palate and the auditory 
tube are smaller than normal, which makes opening 
the auditory tube less effective. Tubular pharyngeal 
part m. palatopharingeus, which reveals the mouth of 
the auditory tube, is also involved in the pathological 
process. It is usually hypoplasized, as a result of 
which the mouth of the auditory tube is smaller than 
in healthy children or is not identified at all. In 
addition to the incorrect attachment of muscles, there 
are other anatomical and histological features that 
negatively affect the function of the auditory tube. It 
was revealed that lateral and medial cartilaginous 
plates of auditory tube have lower elasticity (due to 
low density of elastin) and dimensions, which leads to 
reduction of curvature of lumen of eustachian tube 
[10]. 
A small cleft of the soft palate is a relatively simple 
surgical problem with extremely good long-term 
prognosis in most cases, while a wide full cleft of the 
palate can be closed with difficulty, especially at the 
junction of hard palate and soft palate, and this can 
lead to significant speech difficulty and long-term jaw 
growth impairment caused by scarring. Eurocleft 
studies conducted for multiple interventions in 
children with cleft anomalies, which were conducted 
in an incoherent and inconsistent manner, combined 
with observations of adequate growth patterns in 
individuals with undecided cleft, revealed the 
following. These are fears that in some cases 
postoperative distortions resulting from scarring and 
improperly calculated or performed operations 
created defects that could compete with the crevices 
themselves. [2]. 
For effective integrated treatment of children with 
CCLP, it is necessary to periodically study dynamics 
of growth of jaw segments [11].  
The development and growth of the nasal and 
maxillary complex in patients with CCLP is a widely 
discussed topic in any surgical procedure. The Graber 
studies report three-dimensional changes in the upper 
jaw in patients with complete lip and palate defects, 
as well as in patients after surgery. In patients, a 
tendency was found to shift the bite, cross the anterior 
and posterior bites, and defects in the midline of the 
face. Two factors have been shown to cause abnormal 
facial morphology in patients with CCLP undergoing 
surgery: internal defect development and iatrogenic 
factors resulting from treatment [12]. 
Bishara reported that maxillary deformation in 
patients with CCLP was caused by internal factors, 
but most authors noted that internal jaw factors were 
secondary to surgical interventions [13]. If the 
deformation of the maxillae is a complication of 
surgery, it is important to determine the optimal 
duration and conditions of treatment in order to close 
the defects of the lip and palate [14, 15]. Determining 
the cause of stunting in patients with CCLP has been 
the subject of a large number of studies, and the 
initial consensus now is that the iatrogenic effect of 
surgery is a relatively important factor.  
In patients with CCLP before surgery, a slight 
increase in the upper jaw was observed, which led to 
more attention to the study of iatrogenic factors [16]. 
According to some authors, the main factor in 
stunting is the operation carried out in the palate. In 
patients with palate defects, the mean value is usually 
taken into account in the criteria for assessing growth, 
and then correlated with other patients with palate and 
palate defects or with a normal population [17]. 
It is important to indicate the mean value of treatment 
outcomes, but assessing individual variability is 
relatively difficult. Changes in development have 
been noted by many authors [18, 19]. These changes 
may depend on the type of crack and its complexity. 
To date, it has not been established whether the 
surgery really limits the growth of maxillae and 
mandible. Therefore, to assess the effectiveness of 
surgical interventions for cranial and facial growth in 
lip and palate defects, we conducted a study in 
patients with CCLP [20, 21]. 
Studies conducted by Stepina S.V. (2006) showed 
that during the period of the formed milk bite in 
children with congenital bilateral cleft of the upper lip 
and palate there is an underdevelopment of maxillae 
in height, an increase in the base of maxillae in 
length, an increase in the angle of inclination of 
mandible in front of the base of the skull, deployment 
of the lower jaw angle in the period of the early 
replacement bite [22]. As the child grows, the degree 
of anatomical disorders is determined by the 
adequacy of surgical and orthodontic treatment. In 
some cases, despite the observance of all the 
principles of complex treatment, it is not possible to 
completely eliminate the deformation of the 
maxillofacial region [23]. Numerous studies have 
detailed the severity of anatomical and functional 
disorders in children with congenital bilateral cleft of 
the upper lip and palate. The complexity of the vice 
necessitates further study of the problem.  
When examining patients with congenital bilateral 
cleft of the upper lip and palate during the bite of 
milk 
teeth, 
clinical, 
radiological, 
graphic, 
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anthropometric and other special methods for 
diagnosing the pathology of the maxillofacial region 
(ultrasound, functional diagnostic methods) are used 
[24]. Clinical methods of examination include 
external examination of the face, assessment of upper 
lip symmetry, and presence of nasal deformation, 
mouth opening functions, oral mucosa condition, 
degree of protrusion of the intermaxillary bone, 
degree of its mobility, and degree of deformation of 
lateral fragments of maxillae alveolar process [25]. 
When making anthropometric measurements, faces 
use photographic pictures in straight and lateral 
projections. Height of face, height of nasal part of 
face, nose, gnatic part of face, width in area of 
zygomatic bones, nose, etc. are determined [26]. 
Shulzhenko V.I. et al. (2016) in children with 
congenital bilateral cleft lip and palate, diagnostic 
models were studied by Silman method, comparing 
dental alveolar arches of children with orthognatic 
bite [27].I-24 
An external examination assessed the configuration of 
the face, the state of the skin, the red border of the 
lips, the severity of external anatomical landmarks, 
etc. The patient's face was photographed. Photometric 
examination was carried out to assess symmetry 
relative to the median sagittal line, the cosmetic 
center of the face, and the cosmetic center of the 
upper dentition. This made it possible to detect 
deviations of the incisional line of the upper dentition 
relative to the midline of the face in one direction or 
another. Measurements were carried out by an 
electronic ruler. When examining the oral cavity, the 
patient was evaluated: the presence of morphological 
disorders of the upper jaw and the dentate system as a 
whole, the presence of super-complete incisors from 
the cleft side and the absence of complete incisors, 
both from the cleft side and from the opposite side. 
Measurements of jaw models of children with CCLP 
aged 1 to 6 months were carried out before lip 
reconstruction. For measurement, a longitudinal line 
was drawn passing through the middle of the wedge-
shaped part of the ploughshare, since its front part, 
connected to the intercellular bone, deviates in the 
transversal plane. The apex of the upper lip bridle and 
the apex of the anterior segment of the small fragment 
of 
the 
alveolar 
process were determined, 
measurements were taken from the longitudinal axis 
to the indicated points, and the obtained value 
corresponds to the displacement of the processes from 
the transversal plane. The projection distance of these 
points on the longitudinal axis was also taken into 
account; this value indicates the displacement of 
fragments in the sagittal plane [28].  
In addition, today, despite a large number of domestic 
and foreign studies, the problem of optimal timing for 
surgical operations on the lip and palate is widely 
discussed. The criteria for completion of early 
preoperative orthopedic therapy are not defined, and 
diagnostic methods in the early stages of treatment 
are not systematized. To assess the harmony of the 
nasolabial triangle, photometry of the child's face was 
carried out. The photography was carried out in a 
position when the subject was sitting straight; the 
look was directed towards the lens. Photography was 
carried out using a photo system (Canon D450 Kit 
mirror camera; lens EF 24 - 85mm f/3.5-4.5). 
Photography was carried out after obtaining informed 
voluntary consent of parents to examine their children 
in accordance with ethical and legal standards. 
Photographs of the subject's face are calculated 
according to the developed methodology for 
analyzing the harmony of the nasolabial triangle 
(certificate for rationalization proposal №. 2771 of 
28.08.2018). To do this, the following points are 
placed: points of the corners of the mouth on the right 
and left; points on the top of the Cupid arch on the 
right and left; bottom point; base points of the nose 
wings on the right and left; points on the top of the 
nostrils on the right and left. Then, corners of mouth, 
tray point and points of Cupid's arch are connected 
with straight lines, framing filter, tray point with 
points on nostril tops and base of nose wings, the 
latter are connected with corners of mouth. A line 
passing through the middle of the filter is also carried 
out. Dental components of the overall quality of life 
parameter of children with CCLP were evaluated in 
the dynamics of treatment in children at 2 years and at 
4 years using the proxy-report approach (assessment 
of the quality of life of children by parents). To do 
this, the Russian-language version of the ECOHIS 
questionnaire (Early Childhood Oral Health Impact 
Scale) was used, since it is used in children of this age 
category. In addition, it is easy to use, and its 
questions are understandable to parents. 108 parent-
child couples took part in assessing the quality of life. 
The parents' questionnaire was carried out 
individually, after familiarizing them with the 
instructions for completing the questionnaire [29].  
Early orthodontic treatment of patients with bilateral 
crevices of a bay and sky by means of "The obturator 
dental for orthodontic treatment of children with a 
congenital full bilateral cleft lip and palate" 
contributes to normalization of the situation of an 
intermaxillary bone and vomer, brings together an 
intermaxillary bone, fragments of front department of 
maxillae, reduce a tension of tissues of upper lip after 
a cheiloplasty and also is prevention of secondary 
deformation of wings and a tip of a nose [30]. 
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The effectiveness of orthodontic treatment was 
evaluated 12 months after the start of therapy based 
on the results of morphometric examination of 
children's facial parameters, biometric measurement 
of jaw models. The criteria for the effectiveness of 
treatment were considered: achieving optimal 
functional occlusion, reducing the amount of 
protrusion of the intercellular process of the maxillae, 
reducing the degree of deviation of the intercellular 
process of maxillae, expanding the lateral parts of the 
upper dentition. Comparative analysis of data from 
morphometric studies of children's facial parameters 
and biometric measurements of jaw models after 
orthodontic treatment was carried out, both between 
the observation groups and in comparison with the 
data of children with physiological occlusion. After 
primary cheiloplasty in all children, the nasal 
deformation in the form of shortening the columella 
and flattening the wings of the nose was determined 
with varying degrees of severity. After cycling and 
uranoplasty, good results of surgery were noted in 34 
(77.2%) children. A satisfactory treatment outcome 
was determined in 10 (22.7%) children. Thus, 
children with congenital bilateral complete cleft of 
the upper lip and palate, after completing the main 
surgical stages of treatment (cheilo-, velo- and 
uranoplasty), were characterized by a violation of 
face harmony and occlusion [31]. 
Based on the axiography, the shape and inclination of 
the articular pathway were studied, trajectory quality, 
quantity 
characteristics. Movements, 
shape, 
symmetry, coincidence of curves during various 
movements of mandible, characterizing the functional 
state temparo-mandibular joint (TMJ) and intra-
articular disk. Rust-retrusion tests were tvaluated 
movements of the mandible heads in the sagittal, 
transversal and frontal planes, mediotrusion, opening 
and closing of the mouth. A characteristic point for all 
patients was the absence of active complaints from 
TMJ, despite the presence in many cases of 
pronounced functional joint disorders, such as 
clicking when opening and closing the mouth, as well 
as deviation during lower movement jaws. More 
significant disorders noted in the group of patients 
with unilateral cleft lip and palate compared to the 
group of patients with a bilateral full cleft of the 
upper lip, alveolar process, hard and soft skies. 
Functional on the cleft side revealed joint head 
movement disturbances, and structural disturbances 
of 
joint head and TMJ disc motion path, 
hypermobility ligament apparatus [32]. All the 
methods of cheiloplasty carried out allowed: to form 
the upper lip, to create all its anatomical parameters, 
to compare muscles in the position of myodynamic 
equilibrium, to form the upper vault of the vestibule 
of the mouth. Corrections of the skin-cartilage of the 
nose are postponed up to 12-16 years [33]. 
According to Sharopov S.G. (2019), the goal of early 
operations is to reduce the period of maladaptation of 
the child. The purpose of using sparing versions of 
uranoplasty is to reduce the conditions for the 
formation of multiple scarring, which contributes to 
the development of secondary deformations of 
maxillae. Trauma of bone structures of palate during 
operation restrains further development of jaw bones 
and exacerbates secondary deformities of jaws, dental 
rows and whole middle zone of face [34]. 
Conclusion: Thus, the morphogenesis of the upper 
lip and palate is a complex process associated with a 
tightly regulated interaction between mesenchymal 
and epithelial cells, requiring further research. 
Analysis of the studied scientific and medical 
literature showed that in published sources the 
morphometric characteristic of the craniofacial region 
of children of the I and II childhood period with 
congenital cleft lips and palate is not presented in 
sufficient volume. With the help of this article, a 
number of tasks can be solved: to determine the 
morphometric parameters of the craniofacial region in 
children of the I and II childhood period in healthy 
children taking into account gender (boys and girls), 
to assess the correspondence of these parameters to 
the "golden section principle"; identify features of 
changes in the parameters of the dentate system 
during the period of tooth change in children with 
congenital cleft labia and palate in a comparative 
aspect; determine the state of bite in children with 
congenital cleft labia and palate depending on age, as 
well as determine the optimal timing of surgical 
treatment. 
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