Nasolabial aesthetics correlates poorly with skeletal symmetry in unilateral cleft lip and palate Wanda Urbanova a , Andrzej Brudnicki b , Hardus Strydom c , Ewald M. Bronkhorst d , Christos Katsaros e , Piotr S. Fudalej c,f, * a Department of Orthodontics and Cleft Anomalies, 3rd Medical Faculty, Charles University, Prague, Czech Republic b Department of Pediatric Surgery, Institute of Mother and Child, Warsaw, Poland c Department of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands d Department of Preventive and Restorative Dentistry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands e Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland f Department of Orthodontics, Palacky University Olomouc, Olomouc, Czech Republic Received 12 October 2011; accepted 27 August 2012 KEYWORDS Cleft lip; Cleft palate; Aesthetics; Nasolabial appearance; One-stage repair Summary Objective: To evaluate the correlation between symmetry of the craniofacial skel- eton and aesthetics of the nose and upper lip in children with complete unilateral cleft lip and palate (CUCLP). Material and methods: Craniofacial symmetry was evaluated on postero-anterior (PA) cepha- lograms of 54 children (37 boys and 17 girls; mean age Z 11.0 years, SD 1.6) with CUCLP re- paired with a one-stage closure (Cleft group). Treated subjects were age- and gender- matched with 54 untreated subjects taken from the University of Michigan Growth Study (Control group). Fourteen coefficients of asymmetry (CAs) were calculated and four angles were measured. Four raters assessed the nasolabial appearance on cropped facial and profile photographs with the 5-grade aesthetic index of Asher-McDade (grade 1 means the most aesthetic and grade 5 the least aesthetical outcome) in the Cleft group only. Independent t-tests were used to evaluate the inter-group differences for CAs. Pearson’s correlation coef- ficients were calculated to examine a relationship between particular components of the aesthetical index and CAs. Multiple regression analyses were carried out to explain the naso- labial aesthetics on the basis of craniofacial symmetry. Results: In the Cleft group, most cephalometric variables demonstrated asymmetry not exceeding 10%. The Cleft and Control groups differed regarding three angular measurements (Se, Ism, and ANS ) and 1 CA (Mo-V). Three of the four nasolabial components demonstrated correlation with some cephalometric variables. However, the correlation coefficients were low (range: e0.309 to 0.305). * Corresponding author. Department of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. Tel.: þ31 243614005. E-mail addresses: pfudalej@gmail.com, p.fudalej@dent.umcn.nl (P.S. Fudalej). 1748-6815/$ - see front matter ª 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bjps.2012.08.032 Journal of Plastic, Reconstructive & Aesthetic Surgery (2013) 66, e1ee7