Facial soft-tissue thickness in patients affected by bilateral cleft lip and palate: A retrospective cone-beam computed tomography study Mevlut Celikoglu, a Suleyman K. Buyuk, b Ahmet E. Sekerci, c Mustafa Ersoz, d Salih Celik, e and Yildiray Sisman f Antalya, Kayseri, and Malatya, Turkey Introduction: The purposes of this study were to evaluate the facial soft-tissue thicknesses and craniofacial morphologies of patients affected by bilateral cleft lip and palate (BCLP) and to compare the findings with a well-matched control group without any clefts using cone-beam computed tomography. Methods: The study sample consisted of 40 retrospectively and randomly selected patients divided into 2 groups: a BCLP group (20 patients; mean age, 13.78 6 3.20 years) and an age- and sex-matched control group without clefts (20 patients; mean age, 13.94 6 2.52 years). Craniofacial and facial soft-tissue thickness measurements were made with cone-beam computed tomography. The Student t test and multiple linear regression analyses were performed for the statistical evaluations. Results: The BCLP group had an increased SN-MP angle (P 5 0.003), a decreased Co-A (P 5 0.000), and retruded maxillary (P 5 0.000) and mandibular (P 5 0.026) incisors. In addition, patients affected by BCLP had statistically significantly decreased thickness measurements for the variables subnasale (P 5 0.005) and labrale superior (P 5 0.026) compared with the controls. The most predictive variables were found at U1-SN (r 5 0.417, P 5 0.004), IMPA (r 5 0.368, P 5 0.010), and ANB (r 5 0.297, P 5 0.031) for subnasale and U1-SN (r 5 0.284, P 5 0.038) for labrale superior. Conclusions: The BCLP group showed greater vertical growth, greater retrusion of the maxilla and the maxillary and mandibular incisors, and decreased subnasale and labrale superior thicknesses compared with the well-matched controls without clefts. These differences should be taken into account when planning orthodontic and orthognathic surgery treatment for those patients. (Am J Orthod Dentofacial Orthop 2014;146:573-8) A ssessment of the soft tissues in patients undergo- ing orthodontic treatment or corrective jaw sur- gery plays a crucial role in both diagnosis and treatment planning. 1 Both hard-tissue and soft-tissue morphologies of the patients to be orthodontically treated should be considered in establishing harmonious facial esthetics and an optimal functional occlusion. 2 Cleft lip and palate (CLP) is a common congenital craniofacial anomaly with a multifactorial etiology. 3,4 CLP leads to various problems with feeding, hearing, speaking, and dentofacial development; thus, patients affected by CLP should be treated by a multidisciplinary team approach with good interaction among the different specialties. 5 Patients affected by CLP generally have anterior and posterior crossbites and maxillary defi- ciency with a tendency toward a Class III malocclusion. 6-8 It appears that the scarring produced by the primary surgical repair is a major etiologic factor for the maxillary deficiency. 9 A favorable facial morphology is a key aspect of treat- ment outcome in patients affected by CLP, 10 and the role of orthodontists for these patients' treatment is substan- tial, particularly in the improvement of their facial esthetics and dental occlusion. 11 In the literature, several studies have assessed the hard-tissue and soft-tissue a Associate professor, Department of Orthodontics, Faculty of Dentistry, Akdeniz University, Antalya, Turkey. b Research assistant, Department of Orthodontics, Faculty of Dentistry, Erciyes University, Kayseri, Turkey. c Assistant professor, Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Erciyes University, Kayseri, Turkey. d Assistant professor, Department of Orthodontics, Faculty of Dentistry, Inonu University, Malatya, Turkey. e Assistant professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Antalya, Turkey. f Associate professor, Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Erciyes University, Kayseri, Turkey. All authors have completed and submitted the ICMJE Form for Disclosure of Po- tential Conflicts of Interest, and none were reported. Address correspondence to: Mevlut Celikoglu, Department of Orthodontics, Fac- ulty of Dentistry, Akdeniz University, Dumlupinar Bulvari, Antalya 07058, Turkey; e-mail, mevlutcelikoglu@hotmail.com. Submitted, February 2014; revised and accepted, July 2014. 0889-5406/$36.00 Copyright Ó 2014 by the American Association of Orthodontists. http://dx.doi.org/10.1016/j.ajodo.2014.07.005 573 ORIGINAL ARTICLE