Skip to main content

Advertisement

SpringerLink
Log in

Nasolabial symmetry and esthetics in cleft lip and palate: analysis of 3D facial images

  • Original Article
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

To determine the relationship between nasolabial symmetry and esthetics in subjects with orofacial clefts.

Material and methods

Eighty-four subjects (mean age 10 years, standard deviation 1.5) with various types of nonsyndromic clefts were included: 11 had unilateral cleft lip (UCL); 30 had unilateral cleft lip and alveolus (UCLA); and 43 had unilateral cleft lip, alveolus, and palate (UCLAP). A 3D stereophotogrammetric image of the face was taken for each subject. Symmetry and esthetics were evaluated on cropped 3D facial images. The degree of asymmetry of the nasolabial area was calculated based on all 3D data points using a surface registration algorithm. Esthetic ratings of various elements of nasal morphology were performed by eight lay raters on a 100 mm visual analog scale. Statistical analysis included ANOVA tests and regression models.

Results

Nasolabial asymmetry increased with growing severity of the cleft (p = 0.029). Overall, nasolabial appearance was affected by nasolabial asymmetry; subjects with more nasolabial asymmetry were judged as having a less esthetically pleasing nasolabial area (p < 0.001). However, the relationship between nasolabial symmetry and esthetics was relatively weak in subjects with UCLAP, in whom only vermilion border esthetics was associated with asymmetry.

Conclusions

Nasolabial symmetry assessed with 3D facial imaging can be used as an objective measure of treatment outcome in subjects with less severe cleft deformity. In subjects with more severe cleft types, other factors may play a decisive role.

Clinical significance

Assessment of nasolabial symmetry is a useful measure of treatment success in less severe cleft types.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Aharon I, Etcoff N, Ariely D, Chabris CF, O’Connor E et al (2001) Beautiful faces have variable reward value: fMRI and behavioral evidence. Neuron 32:537–551

    Article  PubMed  Google Scholar 

  2. O’Doherty J, Winston J, Critchley H, Perrett D, Burt DM et al (2003) Beauty in a smile: the role of medial orbitofrontal cortex in facial attractiveness. Neuropsychologia 41:147–155

    Article  PubMed  Google Scholar 

  3. Dion K, Walster E, Berschei E (1972) What is beautiful is good. J Pers Soc Psychol 24:285

    Article  PubMed  Google Scholar 

  4. Langlois JH, Kalakanis L, Rubenstein AJ, Larson A, Hallam M et al (2000) Maxims or myths of beauty? A meta-analytic and theoretical review. Psychol Bull 126:390–423

    Article  PubMed  Google Scholar 

  5. Eagly AH, Makhijani MG, Ashmore RD, Longo LC (1991) What is beautiful is good, but—a meta-analytic review of research on the physical attractiveness stereotype. Psychol Bull 110:109–128

    Article  Google Scholar 

  6. Benson PL, Karabenick SA, Lerner RM (1976) Pretty pleases—effects of physical attractiveness, race, and sex on receiving help. J Exp Soc Psychol 12:409–415

    Article  Google Scholar 

  7. Ritts V, Patterson ML, Tubbs ME (1992) Expectations, impressions, and judgments of physically attractive students—a review. Rev Educ Res 62:413–426

    Article  Google Scholar 

  8. Rhodes G (2006) The evolutionary psychology of facial beauty. Annu Rev Psychol 57:199–226

    Article  PubMed  Google Scholar 

  9. Cunningham MR, Roberts AR, Wu CH, Barbee AP, Druen PB (1995) Their ideas of beauty are, on the whole, the same as ours—consistency and variability in the cross-cultural perception of female physical attractiveness. J Pers Soc Psychol 68:261–279

    Article  Google Scholar 

  10. Perrett DI, May KA, Yoshikawa S (1994) Facial shape and judgments of female attractiveness. Nature 368:239–242

    Article  PubMed  Google Scholar 

  11. Rhodes G, Yoshikawa S, Clark A, Lee K, McKay R et al (2001) Attractiveness of facial averageness and symmetry in non-Western cultures: in search of biologically based standards of beauty. Perception 30:611–625

    Article  PubMed  Google Scholar 

  12. Geldart S, Maurer D, Carney K (1999) Effects of eye size on adults’ aesthetic ratings of faces and 5-month-olds’ looking times. Perception 28:361–374

    Article  PubMed  Google Scholar 

  13. Langlois JH, Roggman LA, Casey RJ, Ritter JM, Rieserdanner LA et al (1987) Infant preferences for attractive faces—rudiments of a stereotype. Dev Psychol 23:363–369

    Article  Google Scholar 

  14. Rubenstein AJ, Kalakanis L, Langlois JH (1999) Infant preferences for attractive faces: a cognitive explanation. Dev Psychol 35:848–855

    Article  PubMed  Google Scholar 

  15. Samuels CA, Butterworth G, Roberts T, Graupner L, Hole G (1994) Facial aesthetics—babies prefer attractiveness to symmetry. Perception 23:823–831

    Article  PubMed  Google Scholar 

  16. Samuels CA, Ewy R (1985) Aesthetic perception of faces during infancy. Br J Dev Psychol 3:221–228

    Article  Google Scholar 

  17. Slater A, Quinn PC, Hayes R, Brown E (2000) The role of facial orientation in newborn infants’ preference for attractive faces. Dev Sci 3:181–185

    Article  Google Scholar 

  18. Enquist M, Arak A (1994) Symmetry, beauty and evolution. Nature 372:169–172

    Article  PubMed  Google Scholar 

  19. Jansson L, Forkman B, Enquist M (2002) Experimental evidence of receiver bias for symmetry. Anim Behav 63:617–621

    Article  Google Scholar 

  20. Johnstone RA (1994) Female preference for symmetrical males as a by-product of selection for mate recognition. Nature 372:172–175

    Article  PubMed  Google Scholar 

  21. Perrett DI, Burt DM, Penton-Voak IS, Lee KJ, Rowland DA et al (1999) Symmetry and human facial attractiveness. Evol Hum Behav 20:295–307

    Article  Google Scholar 

  22. Rhodes G, Sumich A, Byatt G (1999) Are average facial configurations attractive only because of their symmetry? Psychol Sci 10:52–58

    Article  Google Scholar 

  23. Russell KA, Waldman SD, Tompson B, Lee JM (2001) Nasal morphology and shape parameters as predictors of nasal esthetics in individuals with complete unilateral cleft lip and palate. Cleft Palate Craniofac J J38:476–485

    Article  Google Scholar 

  24. Fudalej P, Katsaros C, Hozyasz K, Borstlap WA, Kuijpers-Jagtman AM (2012) Nasolabial symmetry and aesthetics in children with complete unilateral cleft lip and palate. Br J Oral Maxillofac Surg 50:621–625

    Article  PubMed  Google Scholar 

  25. Coghlan BA, Matthews B, Pigott RW (1987) A computer-based method of measuring facial asymmetry. Results from an assessment of the repair of cleft lip deformities. Br J Plast Surg 40:371–376

    Article  PubMed  Google Scholar 

  26. Russell KA, Tompson B (2009) Correlation between facial morphology and esthetics in patients with repaired complete unilateral cleft lip and palate. Cleft Palate Craniofac J J46:319–325

    Article  Google Scholar 

  27. Robertsharry DP, Evans R, Hathorn IS (1991) Effects of different surgical regimes on nasal asymmetry and facial attractiveness in patients with clefts of the lip and palate. Cleft Palate Craniofac J J28:274–278

    Article  Google Scholar 

  28. Verhoeven TJ, Coppen C, Barkhuysen R, Bronkhorst EM, Merkx MA et al (2013) Three dimensional evaluation of facial asymmetry after mandibular reconstruction: validation of a new method using stereophotogrammetry. Int J Oral Maxillofac Surg 42:19–25

    Article  PubMed  Google Scholar 

  29. Asher-McDade C, Roberts C, Shaw WC, Gallager C (1991) Development of a method for rating nasolabial appearance in patients with clefts of the lip and palate. Cleft Palate Craniofac J 28:385–390

    Article  PubMed  Google Scholar 

  30. Asher-McDade C, Brattstrom V, Dahl E, McWilliam J, Molsted K et al (1992) A six-center international study of treatment outcome in patients with clefts of the lip and palate: Part 4. Assessment of nasolabial appearance. Cleft Palate Craniofac J 29:409–412

    Article  PubMed  Google Scholar 

  31. Schmitt N (1996) Uses and abuses of coefficient alpha. Psychol Assess 8:350–353

    Article  Google Scholar 

  32. Papamanou DA, Gkantidis N, Topouzelis N, Christou P (2012) Appreciation of cleft lip and palate treatment outcome by professionals and laypeople. Eur J Orthod 34:553–560

    Article  PubMed  Google Scholar 

  33. Hunt O, Burden D, Hepper P, Johnston C (2005) The psychosocial effects of cleft lip and palate: a systematic review. Eur J Orthod 27:274–285

    Article  PubMed  Google Scholar 

  34. Meyer-Marcotty P, Alpers GW, Gerdes ABM, Stellzig-Eisenhauer A (2010) Impact of facial asymmetry in visual perception: a 3-dimensional data analysis. Am J Orthod Dentofacial Orthop 137:168.e1–8

    Google Scholar 

  35. Fudalej P, Katsaros C, Bongaarts C, Dudkiewicz Z, Kuijpers-Jagtman AM (2009) Nasolabial esthetics in children with complete unilateral cleft lip and palate after 1- versus 3-stage treatment protocols. J Oral Maxillofac Surg 67:1661–1666

    Article  PubMed  Google Scholar 

  36. Mercado A, Russell K, Hathaway R, Daskalogiannakis J, Sadek H et al (2011) The Americleft study: an inter-center study of treatment outcomes for patients with unilateral cleft lip and palate part 4. Nasolabial aesthetics. Cleft Palate Craniofac J 48:259–264

    Article  PubMed  Google Scholar 

  37. Hood CA, Bock M, Hosey MT, Bowman A, Ayoub AF (2003) Facial asymmetry—3D assessment of infants with cleft lip & palate. Int J Paediatr Dent 13:404–410

    Article  PubMed  Google Scholar 

  38. Bugaighis I, O’Higgins P, Tiddeman B, Mattick C, Ben Ali O et al (2010) Three-dimensional geometric morphometrics applied to the study of children with cleft lip and/or palate from the North East of England. Eur J Orthod 32:514–521

    Article  PubMed  Google Scholar 

  39. Bell A, Lo TW, Brown D, Bowman AW, Siebert JP, et al (2013) Three-dimensional assessment of facial appearance following surgical repair of unilateral cleft lip and palate. Cleft Palate Craniofac J

  40. Tigue CC, Pisanski K, O’Connor JJM, Fraccaro PJ, Feinberg DR (2012) Men’s judgments of women’s facial attractiveness from two- and three-dimensional images are similar. J VisNov 6;12(12). doi:pii: 3. 10.1167/12.12.3

  41. Howells DJ, Shaw WC (1985) The validity and reliability of ratings of dental and facial attractiveness for epidemiologic use. Am J Orthod Dentofacial Orthop 88:402–408

    Article  Google Scholar 

  42. Grant S, Aitchison T, Henderson E, Christie J, Zare S et al (1999) A comparison of the reproducibility and the sensitivity to change of visual analogue scales, Borg scales, and Likert scales in normal subjects during submaximal exercise. Chest 116:1208–1217

    Article  PubMed  Google Scholar 

  43. Grossman SA, Sheidler VR, Mcguire DB, Geer C, Santor D et al (1992) A comparison of the hopkins pain rating instrument with standard visual analog and verbal descriptor scales in patients with cancer pain. J Pain Symptom Manage 7:196–203

    Article  PubMed  Google Scholar 

  44. Williamson A, Hoggart B (2005) Pain: a review of three commonly used pain rating scales. J Clin Nurs 14:798–804

    Article  PubMed  Google Scholar 

  45. Svensson E (2000) Concordance between ratings using different scales for the same variable. Stat Med 19:3483–3496

    Article  PubMed  Google Scholar 

  46. Knutsson I, Rydstrom H, Reimer J, Nyberg P, Hagell P (2010) Interpretation of response categories in patient-reported rating scales: a controlled study among people with Parkinson’s disease. Health Qual Life Outcomes 8:61

    Article  PubMed Central  PubMed  Google Scholar 

  47. Eliason MJ, Hardin MA, Olin WH (1991) Factors that influence ratings of facial appearance for children with cleft-lip and palate. Cleft Palate Craniofac J J28:190–193

    Article  Google Scholar 

  48. Gkantidis N, Papamanou DA, Christou P, Topouzelis N (2013) Aesthetic outcome of cleft lip and palate treatment. Perceptions of patients, families, and health professionals compared to the general public. J Craniomaxillofac Surg 41:e105–e110

    Article  PubMed  Google Scholar 

  49. Mani MR, Semb G, Andlin-Sobocki A (2010) Nasolabial appearance in adults with repaired unilateral cleft lip and palate: relation between professional and lay rating and patients’ satisfaction. J Plast Surg Hand Surg 44:191–198

    Article  PubMed  Google Scholar 

  50. Halberstadt J, Rhodes G (2003) It’s not just average faces that are attractive: computer-manipulated averageness makes birds, fish, and automobiles attractive. Psychon Bull Rev 10:149–156

    Article  PubMed  Google Scholar 

  51. Bongaarts CAM, Prahl-Andersen B, Bronkhorst EM, Spauwen PHM, Mulder JW et al (2008) Effect of infant orthopedics on facial appearance of toddlers with complete unilateral cleft lip and palate (Dutchcleft). Cleft Palate Craniofac J J45:407–413

    Article  Google Scholar 

  52. Meyer-Marcotty P, Kochel J, Boehm H, Linz C, Klammert U et al (2011) Face perception in patients with unilateral cleft lip and palate and patients with severe Class III malocclusion compared to controls. J Craniomaxillofac Surg 39:158–163

    Article  PubMed  Google Scholar 

  53. Benz MLX, Maier T, Nkenke E, Seeger S, Neukam FW, Hausler G (2002) Vision, modeling, and visualization; Greiner G NH, Ertl T, Girod B, Seidel HP, editor. IOS Press, Amsterdam, pp 332–339

    Google Scholar 

  54. Nkenke E, Langer A, Laboureux X, Benz M, Maier T et al (2003) Validation of in vivo assessment of facial soft-tissue volume changes and clinical application in midfacial distraction: a technical report. Plast Reconstr Surg 112:367–380

    Article  PubMed  Google Scholar 

  55. Hartmann J, Meyer-Marcotty P, Benz M, Haeusler G, Stellzig-Eisenhauer A (2007) Reliability of a method for computing facial symmetry plane and degree of asymmetry based on 3D-data. J Orofac Orthop 68:477–490

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors report no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, The Netherlands

    Dries J. Desmedt, Mette A. Kuijpers & Anne Marie Kuijpers-Jagtman

  2. Department of Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands

    Thomas J. Maal

  3. Cleft Palate Craniofacial Unit, Radboud University Medical Center, Nijmegen, The Netherlands

    Mette A. Kuijpers & Anne Marie Kuijpers-Jagtman

  4. Department of Preventive and Curative Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands

    Ewald M. Bronkhorst

  5. Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland

    Piotr S. Fudalej

  6. Department of Orthodontics, Palacky University Olomouc, Olomouc, Czech Republic

    Piotr S. Fudalej

Authors
  1. Dries J. Desmedt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas J. Maal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mette A. Kuijpers
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ewald M. Bronkhorst
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anne Marie Kuijpers-Jagtman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Piotr S. Fudalej
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Piotr S. Fudalej.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Desmedt, D.J., Maal, T.J., Kuijpers, M.A. et al. Nasolabial symmetry and esthetics in cleft lip and palate: analysis of 3D facial images. Clin Oral Invest 19, 1833–1842 (2015). https://doi.org/10.1007/s00784-015-1445-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-015-1445-0

Keywords

Search

Navigation