Annals of anatomy = Anatomischer Anzeiger : official organ of the Anatomische Gesellschaft · 2026
Longitudinal Development of Facial Symmetry after Primary Cleft Lip Repair: A Comparison of Subperiosteal and Supraperiosteal Techniques.
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Buckova Michaela, Heyse Nathalie, Petr Jan, Pradel Winnie, Lauer Günter, Keil Christiane
Аннотация
BACKGROUND: Primary cleft lip repair aims to restore both function and aesthetics of the nasolabial complex. Although several surgical techniques provide comparable functional outcomes, their long-term effects on facial symmetry remain unclear. This study compared postoperative facial symmetry following supraperiosteal and subperiosteal primary cleft lip repair using standardized photographic and digital anthropometric analysis.
METHODS: This retrospective monocentric study included 46 patients with non-syndromic unilateral cleft lip and palate. Patients underwent either supraperiosteal repair or subperiosteal reconstruction. Standardized frontal photographs obtained at 0.5, 0.8, 6, and 10 years of age were analyzed. Facial asymmetry was evaluated by visual axis analysis and quantitative landmark-based measurements relative to predefined reference axes. Effect sizes were calculated using Cohen's d.
RESULTS: The subperiosteal repair group demonstrated consistently lower facial asymmetry and greater stability of symmetry development throughout follow-up than the supraperiosteal group. At 10 years, asymmetry of the cupid's bow and lateral nasal wing was reduced by approximately 77% and 84%, respectively, while medial canthus asymmetry was reduced by 59%. The largest between-group differences were observed in the periorbital, nasal, and perioral regions, with large effect sizes for the medial canthus (d = 1.25), lateral nasal wing (d = 1.38), and cupid's bow (d = 1.29).
CONCLUSIONS: Subperiosteal primary cleft lip repair was associated with improved long-term facial symmetry and greater stability of symmetry development over a 10-year follow-up period. Optimization of primary cleft lip repair techniques may improve long-term aesthetic outcomes and reduce the need for secondary corrective procedures.
METHODS: This retrospective monocentric study included 46 patients with non-syndromic unilateral cleft lip and palate. Patients underwent either supraperiosteal repair or subperiosteal reconstruction. Standardized frontal photographs obtained at 0.5, 0.8, 6, and 10 years of age were analyzed. Facial asymmetry was evaluated by visual axis analysis and quantitative landmark-based measurements relative to predefined reference axes. Effect sizes were calculated using Cohen's d.
RESULTS: The subperiosteal repair group demonstrated consistently lower facial asymmetry and greater stability of symmetry development throughout follow-up than the supraperiosteal group. At 10 years, asymmetry of the cupid's bow and lateral nasal wing was reduced by approximately 77% and 84%, respectively, while medial canthus asymmetry was reduced by 59%. The largest between-group differences were observed in the periorbital, nasal, and perioral regions, with large effect sizes for the medial canthus (d = 1.25), lateral nasal wing (d = 1.38), and cupid's bow (d = 1.29).
CONCLUSIONS: Subperiosteal primary cleft lip repair was associated with improved long-term facial symmetry and greater stability of symmetry development over a 10-year follow-up period. Optimization of primary cleft lip repair techniques may improve long-term aesthetic outcomes and reduce the need for secondary corrective procedures.